Causes and management of peripheral oedema in palliative care

Patients with an advanced life-limiting illness can develop peripheral oedema of the limbs, sacrum or genitals. Contributing factors include:

Management of peripheral oedema in patients with palliative care needs is guided by potential benefits and burdens of treatment, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care. Management includes:

  • addressing the contributing factors (see above), if appropriate
  • managing symptoms (eg leg elevation, scrotal supports for scrotal oedema, managing pain)
  • preventing complications (eg meticulous skincare)
  • prompt management of complications, such as cellulitis (eg antibiotics, if appropriate) and lymphorrhoea (lymph leakage) (eg gentle bandaging with retention bandages or a tubular bandage, or wrapping with large dressings or clean towels)
  • assisting the patient to maintain function as much as possible.

Other than for the management of symptoms associated with heart failure, diuretics are of limited value in treating peripheral oedema, because the oedema that occurs with advanced life-limiting illness is complex and multifactorial. In addition, diuretics can cause significant adverse effects.

If applied incorrectly, compression bandaging can cause skin damage due to inappropriately applied pressure, and may exacerbate peripheral oedema by increasing venous return and aggravating or precipitating heart failure. For this reason, compression bandaging should only be used by healthcare professionals trained in the technique, and patients and carers who have been taught how to do it.