References
Introducing the British Lymphology Society position paper on ankle brachial pressure index
Abstract
Prompt application of appropriate compression therapy is essential for effective treatment of lymphoedema. However, it is accepted that prior to the application of compression to the lower limbs, either with bandaging or compression garments, patients should demonstrate a satisfactory vascular status, as assessed via axillary brachial pressure index (ABPI). Unfortunately, the presence of peripheral oedema may render a reading impossible or grossly inaccurate. Relying solely on ABPI assessment is potentially harmful to patients, who may be denied appropriate treatment or experience complications and deterioration of their condition due to delayed treatment. The British Lymphology Society recognises a need to focus more on clinical assessment skills to determine vascular status, rather than relying on ABPI alone. Thus, the Society has developed guidance and a practical tool to support clinical decision-making and enhance practitioner confidence in the safe application of compression therapy in the absence of ABPI.
The best-practice document for the management of lymphoedema (Lymphoedema Framework, 2006) recommends measurement of the ankle brachial pressure index (ABPI) prior to the use of compression therapy, while recognising the limitations of ABPI measurement. Further, the Wounds UK (2015) best-practice statement for compression hosiery only supports the application of compression of 14–17 mmHg in the absence of ABPI.Yet this is not reflected in standard practice in specialist lymphoedema clinics (British Lymphology Society (BLS), 2018).
A position paper on ABPI was launched at the BLS annual conference in 2018, with the aim of supporting decision-making for practitioners and enabling instigation of appropriate compression in the absence of an ABPI. The document references a questionnaire study conducted by Todd et al (2008), which showed that 46% of lymphoedema specialists felt that the ABPI was inaccurate in the presence of lower-limb oedema.The BLS also recognised that, in the field of lymphoedema, there are a considerable number of allied healthcare professionals (e.g. physiotherapists) who specialise in lymphoedema for whom ABPI measurement and wound care are not integral to their training.
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