Palliative Subcutaneous Needle Drainage for a Rare Cause of Refractory Lymphedema: Yellow Nail Syndrome

Yellow nail syndrome (YNS) presents a therapeutic challenge due to its elusive etiology and lack of effective treatments. We present a case of a 77-year-old female with YNS-associated lymphedema who experienced significant symptomatic relief with subcutaneous drainage therapy, a novel intervention not previously described in YNS. Despite prior failed conventional therapies, she achieved remarkable weight loss, improved mobility, and stable biochemical parameters. Subcutaneous drainage therapy, though traditionally utilized in cancer-associated lymphedema, demonstrates promise as an alternative palliative treatment for refractory cases of lymphedema to improve quality of life.

A dual realist review: Compression for leg swelling at the end of life has potential quality of life benefit

AIMS

To examine the evidence for the use of compression in the general population and determine how far it can be used to inform treatment at the end of life.

DESIGN

In advanced illness, some patients suffer lower limb swelling and its resulting problems. In the general population, compression is used to treat lower limb swelling, but little is known about its use at the end of life. This review is designed to deeply explore the available evidence and identify what is known and areas for further research.

DATA SOURCES

Five databases were searched; CINAHL, MEDLINE, Embase, AMED and Cochrane, in November 2021. Reference lists for included studies were hand-searched. A web search was carried out.

REVIEW METHODS

Two parallel realist reviews were performed. The first reviewed the use of compression in the general population. The second explored lower limb swelling at the end of life. Findings were screened using inclusion and exclusion criteria, quality assessed and qualitative and quantitative data extracted.

RESULTS

The initial searches returned 1179 articles in review one and 839 articles in review two. Following the screening, 10 articles remained in each review for analysis. A programme theory was drawn for each review. The theories had sufficient similarities to allow evidence from the general population to be used to make recommendations for those at the end of life.

IMPACT

People with advanced illness and leg swelling suffer physically and psychologically. Compression delivers a reduction in swelling and quality of life benefit in the general population. This study found people with advanced illness may experience the same benefits. A cautious approach should be taken and stockings or adjustable Velcro compression devices (AVCDs) are likely to be the best starter interventions. Existing guidelines should also be consulted. Further research to develop the right intervention in this group is needed.

Treatment of Lower Extremity Edema by Controlled Subcutaneous Drainage at Home: A Case Report

Lower severe edema is a common condition faced by advanced cancer patients with an impact on comfort, quality of life, and care planning. Diuresis and mechanical interventions are the mainstream options for the treatment of edema, but, although effective, may not be indicated for frail, bed-bound, and dependent patients cared for in the community setting.We present a case report of a young female with severe edema to her right lower limb, which accepted controlled subcutaneous fluid drainage at her home. Subcutaneous fluid drainage at home was effective, safe, and feasible and improved the patient's comfort and well-being.

Upper Extremity Subcutaneous Lymphatic Drainage "Lymphocentesis" for Symptom Relief in End-Stage Breast Cancer

Lymphedema is a challenging condition that occurs as a complication to many life-limiting medical conditions. It has a number of associated symptoms including pain, functional impairments, and emotional distress. Majority of treatment interventions have been studied and applied outside of the palliative care context. Subcutaneous drainage is a technique that has been used in some case reports for the lower extremity and sacrum with good results. This report describes an adapted technique of subcutaneous drainage for treating upper extremity lymphedema in the palliative setting.

Palliative care for cancer-related lymphedema: a systematic review

INTRODUCTION

Cancer-related lymphedema management in palliative care remains a challenge for health care professionals. We conducted a systematic review of the published literature related to the effectiveness of cancer-related lymphedema management in the palliative care setting.

METHODS

Eleven major medical databases were searched. Manuscripts were selected for articles published from January 2004 to October 30, 2011, using search terms for lymphedema and palliative care. Eleven articles were selected based on defined eligibility criteria for final review and were categorized as lymphedema management in palliative care by topic experts. Articles were also rated for quality according to the Oncology Nursing Society Putting Evidence into Practice(®) classification.

RESULTS

Five case studies were identified addressing closed-controlled subcutaneous drainage; one retrospective study on manual lymphatic drainage (MLD); two case studies on compression therapy; and three case studies on complete decongestive therapy (CDT). All studies were rated in the category of "effectiveness not established" due to study limitations in design and sample size. Few studies included objective measures of outcomes, and there were no randomized controlled trials. There is a need for larger, well-designed research studies to test the effectiveness of management of cancer-related lymphedema in palliative care.

Subcutaneous lymphatic drainage (lymphcentesis) for palliation of severe refractory lymphedema in cancer patients

Subcutaneous lymphatic drainage has been reported to be an effective treatment for severe refractory lymphedema in patients with lymphatic accumulation because of obstructive cancer. We review published techniques for lymphatic drainage and describe two cases where these techniques were modified with good results.

Multiple subcutaneous puncture and stoma bag drainage for gross lower limb edema: a case report

We present a case of gross lower limb edema in a 21-year-old man with an intra-abdominal malignant fibrous histiocytoma. He had a 1-month history of lower limb edema secondary to inferior vena caval obstruction. His edema failed to respond to a combination of diuretics, oral frusemide 40 mg daily and oral spironolactone 100 mg daily. Subcutaneous drainage of both lower limbs with butterfly needles was performed with minimal improvement. However, he gained significant symptomatic relief with multiple subcutaneous punctures and stoma bag drainage. A total of 12.8 L of serous fluid was drained with this simple and effective method. This is the first report of the use of this method.

Treatment of Lower Extremity Edema by Subcutaneous Drainage in Palliative Care of Advanced Cancer Patients

Background: Lower extremity edema is a problem in patients with advanced cancer, causing decreased physical function and reduced movement. Methods: Eight patients with advanced cancer were treated by subcutaneous needles inserted in the inner and outer sides of the ankles and attached to an enclosed drainage bag, or by creating subcutaneous tracts in both ankles. Results: All patients lost weight after 24 hours. A total of 4 patients reported enhanced mobilization and 5 patients had significant improvement of mobilization that improved their quality of life. Conclusions: Subcutaneous drainage can improve edema in the lower limbs or the lower body segment, contributing to patient comfort at his end-of-life period. A prospective study with better evaluation of patient quality of life is ongoing in our center.