Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the proposed procedure with the patient.
   To ensure that the patient understands the procedure and gives their valid consent (NMC [202]). C
2. 2.Show
   Place the patient in a sitting position with the legs outstretched horizontally, preferably on a firm couch with adjustable height.
   To ensure the lower limbs are relaxed and supported. The adjustable height means that the measurer can work without straining their back. E

Procedure

1. 3.Show
   Standing to the outside of the leg, ask the patient to flex the foot to a right angle. Measure the distance from the base of the heel to the ankle, along the inside of the leg; mark the ankle, allowing at least 2 cm of leg to lie below the mark, and record the distance on the chart.
   To establish and clearly record a reproducible fixed starting point for all subsequent measurements (Lymphoedema Framework [153], C). Note: the marks represent a point midway through each cylinder segment, they do not represent the base of the cylinder, therefore at least half the segment (i.e. 2 cm) must lie below the mark.
2. 4.Show
   Ask the patient to relax the foot. From the starting point, using a ruler, mark the inside of the leg at 4‐cm intervals along the length of the leg up to the groin.
   Reducing the limb to 4‐cm segments improves the accuracy of measurement since these segments resemble a cylinder more closely than does the whole limb. The formula used here assumes that the measurements are 4 cm apart (Williams and Whitaker [286], E).
3. 5.Show
   Place the tape measure around the limb and measure the circumference at each marked point, recording the measurement on the chart. Make sure that the tape lies smoothly around the relaxed limb and that it does not lie at an angle. (Decide at the outset whether the tape is to be placed above, below or on the mark and keep to the same position every time: document position.)
   Ensuring that there are no gaps between the limb and the tape and that the procedure is the same each time reduces error (Williams and Whitaker [286], E).
4. 6.Show
   Repeat the process on the other leg, whether or not it is swollen.
   If only one limb is affected the normal limb acts as the patient's own control (Williams and Whitaker [286], E).
5. 7.Show
   If desired, a circumference measurement may be taken of the foot but this is not included in the calculation of volume.
   The foot cannot be considered to be a cylinder and it is therefore inappropriate to include it in the calculation of volume.

Post‐procedure

1. 8.Show
   Ensure that the same number of measurements are made and clearly recorded on the record sheet for each leg.
   Accurate documentation will ensure accuracy during limb volume calculation for each limb (Williams and Whitaker [286], E).
2. 9.Show
   Remove the marks from the patient's skin using warm water and a mild soap preparation.
   Removing the marks maintains patient dignity. Mild soap ensures that the skin is not irritated.