Indocyanine Green Lymphography in Conservative Lymphedema Management: An Exploration of the Impact on Lymphedema Therapy Plans

Objectives

Information from indocyanine green (ICG) lymphography (ICG-L) can be used to guide an individual's lymphedema therapy plan. However, the mechanisms for this clinical translation are not well described. This study proposes a novel clinical decision support tool for translating ICG-L findings into individualized lymphedema therapy plans and describes subsequent changes in plan features of manual lymphatic drainage and compression.

Methods

This before-after study compared specific therapy plan features before and after ICG-L for participants with limb lymphedema. After participants had undergone ICG-L, the individuals’ ICG-L findings were translated into an ICG-L–informed therapy plan using a novel clinical decision support tool, ICG-TRANSLATE. A predetermined coding tree was used to identify changes in elements of manual lymphatic drainage and compression therapy plan recommendations.

Results

Following the application of the ICG-TRANSLATE decision support tool, 100% (n = 25) of participants had a change in manual lymphatic drainage recommendations, including elements of terminal nodes, pathway, and technique. Additionally, 88% (n = 22) had a change in compression recommendations, which was most commonly a change in garment limb coverage.

Conclusions

ICG-L findings informed changes to traditional lymphedema therapy plan modalities of manual lymphatic drainage and compression. Whether this change to individual therapy recommendations translates into improved lymphedema outcomes requires further investigation.

Implications for Nursing Practice

A clinical decision support tool may assist practitioners in translating ICG-L findings into individualized lymphedema therapy plans for people with lymphedema. Further exploration is necessary to determine if the management changes derived through ICG-L–informed therapy plans improve outcomes for people with lymphedema.