For clinicians and patients
Refer early. Stage 1 is a different condition from stage 3.
Lymphoedema referrals are accepted from doctors, clinical officers, nurses, physiotherapists and oncology teams anywhere in Kenya and across the entire African continent, and directly from patients. This page sets out who to refer, what to send, and what to check before anyone is placed in compression.
Who to refer
When in doubt, refer. An assessment that rules lymphoedema out is quick and costs the patient very little.
Refer any of these, at any stage
- Before cancer surgery. Any patient scheduled for axillary, inguinal or pelvic lymph node dissection, or nodal radiotherapy — for baseline limb measurement and pre-operative education. This is the single highest-value referral there is.
- After cancer treatment. Any patient reporting heaviness, tightness or asymmetry in a limb on the treated side, with or without visible swelling.
- Persistent one-sided swelling of an arm or leg lasting more than three months once cardiac, renal, hepatic and venous causes have been considered.
- Suspected filarial lymphoedema in patients from the coastal counties, and suspected podoconiosis in patients from affected areas of western Kenya.
- Recurrent cellulitis in the same limb — two or more episodes warrants lymphatic assessment.
- Congenital or adolescent-onset swelling without an obvious cause, including in children.
- Established advanced lymphoedema, including patients previously told nothing could be done.
- Genital and truncal swelling, which is under-reported, rarely volunteered by patients, and treatable.
What to include
A referral with these details can usually be triaged and scheduled on the same day it arrives. Without them, the first appointment is spent gathering history.
Clinical history
- Primary diagnosis and suspected cause of the swelling
- Which limb or region, and how long it has been swollen
- Surgery performed, including which nodes were removed and how many
- Radiotherapy fields and dates
- Number and dates of previous cellulitis episodes
- Whether the swelling reduces overnight
Safety information
- Cardiac, renal and hepatic status
- Known or suspected deep vein thrombosis, past or present
- Peripheral arterial disease, and ankle-brachial pressure index if measured
- Diabetes and current glycaemic control
- Current medications, particularly calcium channel blockers, steroids and diuretics
- Active infection or open wounds
- Known active or recurrent malignancy
If limb circumference measurements are available, please include them. Four-point circumferential measurements taken at fixed distances from a bony landmark, on both limbs, allow objective tracking of treatment response from the first visit.
Before compression
Compression is not safe in every swollen limb
Please flag any of the following on the referral. These are not automatic exclusions, but each changes what can safely be applied and in what order:
- Uncontrolled or decompensated heart failure — rapid fluid return can precipitate overload
- Acute deep vein thrombosis or suspected pulmonary embolism
- Acute cellulitis or any untreated infection in the limb
- Significant peripheral arterial disease; compression levels must be reduced or withheld and arterial assessment obtained first
- Severe peripheral neuropathy, where the patient cannot report pain or pressure damage
- Untreated or uncontrolled malignancy in the affected region
Where any of these apply, refer anyway and say so. Assessment, skin care, education and gentle movement can begin while the underlying issue is managed.
What happens next
From referral to maintenance
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Triage, within two working days
Referral reviewed, urgency assigned, and the referring clinician contacted if anything critical is missing.
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Full assessment
History, examination, staging, baseline circumferential measurement of both limbs, skin assessment, and screening for the cautions above.
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Intensive decongestive phase
Manual lymphatic drainage, multilayer short-stretch bandaging, remedial exercise and skin care, with measurement at each visit. Typically two to four weeks depending on stage.
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Measurement and fitting for garments
Once limb volume has stabilised, the patient is measured for compression garments and taught to apply, remove and care for them.
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Maintenance and review
Self-drainage, self-bandaging where needed, and a schedule of review appointments. A written summary goes back to the referring clinician.
Referral form
Completing this form opens a pre-filled email in your own mail application. Nothing is submitted to this website and no patient information is stored here.
Please use patient initials rather than a full name, in line with the Data Protection Act, 2019. Full identifying details can follow in the encrypted or in-person handover.
Send a clinical referral
Referring yourself
You do not need a doctor's letter to ask
Patients and families are welcome to make contact directly. If you have a letter, clinic notes, discharge summary or operation record, bring them — they save time. If you have nothing but a swollen limb and a long story, bring that instead. It is more than enough to start with.
It helps to know when the swelling started, whether it goes down overnight, whether you have had the skin become red and hot at any point, and what you have already tried.
Training
Train your ward, not just your referrals
Hospitals, county and national health teams, training colleges and oncology units across Kenya and the entire African continent can arrange lymphoedema in-service training, workshops and structured certification through the curriculum framework developed at Kenyatta National Hospital. Sessions cover recognition, staging, safe compression, skin care and the construction of a referral pathway that actually functions.