Abstract
Purpose: Upper-limb edema commonly occurs among critically ill patients due to immobility, inflammation, and fluid overload, leading to discomfort, impaired mobility, and higher pressure injury risk. Based on lymphatic physiology and prior evidence, this quality improvement (QI) project aimed to reduce edema severity through a structured nurse-led lymphatic massage intervention in the medical intensive care unit (MICU) of a northern Taiwan medical center.
Methods: This QI project was conducted from March to May 2025 using the Plan–Do–Check–Act framework. Baseline audit showed that 75% of patients had moderate to severe edema (≥ +2). Twenty adult patients were enrolled—10 in the intervention group and 10 in the control group. The intervention group received a 30-minute lymphatic massage once daily for three consecutive days, performed by trained ICU nurses using gentle proximal-to-distal circular strokes along lymphatic pathways. The control group received standard care including limb elevation without massage.
Assessment: Edema was evaluated by arm circumference, pitting edema grade, and 0–10 discomfort score. Pitting grading: +1 = 2 mm, immediate rebound; +2 = 3–4 mm, 15 s; +3 = 5–6 mm, 60 s; +4 = 8 mm, 2–3 min. Measurements were performed before and after the three-day intervention by the same nurse for consistency.
Results: After three days, the intervention group showed a mean arm circumference reduction of 2.1 ± 0.6 cm and a decrease in pitting grade from 2.7 ± 0.5 to 1.4 ± 0.5, while controls showed minimal change. Discomfort scores improved by 2.0 points. No adverse effects were noted. Nurses reported the massage was easy, and visibly enhanced comfort (satisfaction 4.8/5).
Discussion: Nurse-led lymphatic massage effectively reduced edema and improved comfort. As a non-invasive method, it aligns with holistic and patient-centered care, empowering nurses to deliver evidence-based comfort interventions.
Implications for Nursing Practice: This project demonstrates that lymphatic massage can be sustainably integrated into ICU protocols to improve circulation, recovery, and comfort. Continuous education and monitoring are recommended. The initiative supports Sustainable Development Goal 3: Good Health and Well-Being, advancing evidence-based and compassionate nursing practice.
Notes
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References:
Thompson, B., Gaitatzis, K., Janse de Jonge, X., Blackwell, R., & Koelmeyer, L. A. (2021). Manual lymphatic drainage treatment for lymphedema: A systematic review of the literature. Journal of Cancer Survivorship, 15(2), 244–258. https://doi.org/10.1007/s11764-020-00928-1
Brix, B., Sery, O., Onorato, A., Ure, C., Roessler, A., & Goswami, N. (2021). Biology of lymphedema. Biology, 10(4), 261. https://doi.org/10.3390/biology10040261
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Acute Care, Advancing Clinical Practice, Lymphedema, Compression Bandages, Lymphatic Massage, Intensive Care Patients, Holistic Medicine
Recommended Citation
Huang, Ying-Fang and Huang, Tzu-Ting, "Lymphatic Massage for Reducing Upper-Limb Edema in ICU Patients: A Quality Improvement Project" (2026). International Nursing Research Congress (INRC). 143.
https://www.sigmarepository.org/inrc/2026/presentations_2026/143
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-06
Lymphatic Massage for Reducing Upper-Limb Edema in ICU Patients: A Quality Improvement Project
Toronto, Ontario, Canada
Purpose: Upper-limb edema commonly occurs among critically ill patients due to immobility, inflammation, and fluid overload, leading to discomfort, impaired mobility, and higher pressure injury risk. Based on lymphatic physiology and prior evidence, this quality improvement (QI) project aimed to reduce edema severity through a structured nurse-led lymphatic massage intervention in the medical intensive care unit (MICU) of a northern Taiwan medical center.
Methods: This QI project was conducted from March to May 2025 using the Plan–Do–Check–Act framework. Baseline audit showed that 75% of patients had moderate to severe edema (≥ +2). Twenty adult patients were enrolled—10 in the intervention group and 10 in the control group. The intervention group received a 30-minute lymphatic massage once daily for three consecutive days, performed by trained ICU nurses using gentle proximal-to-distal circular strokes along lymphatic pathways. The control group received standard care including limb elevation without massage.
Assessment: Edema was evaluated by arm circumference, pitting edema grade, and 0–10 discomfort score. Pitting grading: +1 = 2 mm, immediate rebound; +2 = 3–4 mm, 15 s; +3 = 5–6 mm, 60 s; +4 = 8 mm, 2–3 min. Measurements were performed before and after the three-day intervention by the same nurse for consistency.
Results: After three days, the intervention group showed a mean arm circumference reduction of 2.1 ± 0.6 cm and a decrease in pitting grade from 2.7 ± 0.5 to 1.4 ± 0.5, while controls showed minimal change. Discomfort scores improved by 2.0 points. No adverse effects were noted. Nurses reported the massage was easy, and visibly enhanced comfort (satisfaction 4.8/5).
Discussion: Nurse-led lymphatic massage effectively reduced edema and improved comfort. As a non-invasive method, it aligns with holistic and patient-centered care, empowering nurses to deliver evidence-based comfort interventions.
Implications for Nursing Practice: This project demonstrates that lymphatic massage can be sustainably integrated into ICU protocols to improve circulation, recovery, and comfort. Continuous education and monitoring are recommended. The initiative supports Sustainable Development Goal 3: Good Health and Well-Being, advancing evidence-based and compassionate nursing practice.
Description
This QI project applied nurse-led lymphatic massage to reduce upper-limb edema in ICU patients at a northern Taiwan medical center. After three days, the intervention group showed marked reductions in arm circumference, edema grade, and discomfort. Lymphatic massage was safe, feasible, and sustainable as a holistic nursing intervention.