Therapy, Manual lymph drainage

Manual lymphatic drainage (MLD) | Long-term regulation MLD

The long-term ordinance is an ordinance outside the normal case (as a rule). This means that a rule case must be processed. The health insurance funds have agreed that orders require approval from the fund outside the normal case. In the practical application however many insurances do without the approval procedure. Insurers who do not do without it can then issue this approval for a longer period of time, which then leads to a long-term approval. However, this does not change the "length" of the regulation. Each prescription a.d.R. can receive so many applications that it reaches for 12 weeks, then one must in any case again to the physician. That means 2x MLD per week, theoretically 24x MLD could be prescribed. Download: Application to my health insurance company for long-term approval for prescriptions outside of the usual case

First, subsequent ordinance; ordinance outside the normal case

First prescription:
The first prescription after a new diagnosis or after a 12-week treatment break (the time from the last treatment appointment to the date of issue of the next prescription with the same diagnosis applies here).

Follow-up prescription:
Depending on the indication key/treatment requirement, the first prescription may be followed by different numbers of subsequent prescriptions:

Ly1 (prognostic short-term treatment requirement): one follow-up prescription (a total of 2x6 treatments)
Ly2 (prognostically longer-lasting treatment need): 4 follow-up prescriptions (a total of 5x6 treatments)
Ly3 (chronic lymph drainage disorder in malignant diseases): 4 subsequent prescriptions (a total of 5x10 treatments)

After the exhaustion of all subsequent ordinances or treatments, the rule is exhausted. All further prescriptions, with self-diagnosis and without interruption of 12 weeks (see above) are:

Prescription outside the normal case:
Must be possibly approved by the health insurance, the quantity of treatments can be increased so far that it reaches 12 weeks. (For more information see long-term regulation)

MLD Lymph Drainage

normal treatment time
According to the contracts between drug providers (in this case MLD therapists) and health insurance companies, the standard treatment times include not only the treatment but also all the necessary "preparation and follow-up" of the treatment, e.g:

- Make appointments
- Create Patient and Order in PC
- Check Regulation for Validity
- Complete order for settlement, or settle yourself
- Preparation and follow-up of the room
- circumferential measurement
- write a therapy report if necessary
- collect an additional payment


If possible, at the beginning of the first manual lymphatic drainage, the patient should bring along the necessary materials for the lymphological compression bandage during the decongestion phase. Here the lymphsets offered by different manufacturers and put together for different extremity lymphatic edema (for example Lohmann & Rauscher: arm small / big, leg small / big with synthetic padded bandage or with foam) have proven very successful.

Under ambulatory conditions, it is recommended to apply the first compression bandages with mild pressure. Thus, the patient has the opportunity to get to know the impressive effect of the lymphological compression bandage under emphatically moderate circumstances and to help shape the bandage, which is always to be applied individually, through his daily feedback. In limb lymph edema, this may mean that initially only a light finger-hand or toe-foot bandage is applied. In patients with chronic venous insufficiency, the lymphatic compression bandage makes sense only if it also involves the entire lower leg at the beginning. Here, too, the practitioner can initially create the pressure gradient typical of all lymphological compression dressings from distal "high" to proximal infinitely decreasing "low" in a lighter form.

The highest principle is that a lymphological compression bandage must never be painful! Only when the lymphatic drainage channels at the extremity root are largely free of lymphedema in a limb lymphatic edema, the lymphological compression bandage should be applied to the extremity root or beyond. By choosing the binding material, the therapist determines the depth effect (epi- and / or subfascial space). For the compression of primary and secondary lymphoedema and combination forms (for example, phlebo-lymphoedema, phlebo-lipo-lymphoedema) mainly short-stretch bandages are used. The short-stretch bandage creates a high working pressure and a relatively low static pressure.

While the rubber-elastic Langzugbinde leads with their high static pressure at the required for Lymphödemkompression Press to constrictions with circulatory disorders of the skin, the short stretch bandage allows adequate Lymphödembandage. Exposed bony prominences and protruding tendons often experience irritation due to the high pressure load in the limb bandage. This can be avoided by an appropriate padding next. Upholstery applications directly via these "problem areas" lead to an increase in pressure! The massaging effect that the bandages exert on the underlying tissues can be increased by inserting high-density foam rubber pieces. In this way, even stubborn connective tissue proliferations can be relaxed.

Skin Care

Skin care is an important pillar in the therapy of lymphatic patients. It can prevent complications in compression therapy and is also extremely important in the treatment of lymphedema and the skin problems it causes. Which skin problems can be prevented with the right care? Wound rose is one of the most common complications in lymphoedema. It occurs more frequently in lymph patients because the lymphatic drainage is slowed down and the lymphatic lakes stand still. This reduces the immune defence.

It is important that the skin care is carried out regularly. Patients should choose products that are comfortable for them to use, so that they can really use them every day. Ideally, the skin should be cared for in the evening after the compression stockings have been removed. The product should contain as few ingredients as possible to avoid allergic reactions. However, urea is an indispensable ingredient. The proportion of skin care products should be five to ten percent. Prof. Dr. Markus Stücker. Further


In the flat knitting method, in contrast to the so-called circular knitting method, a flat, two-dimensional knit fabric is produced. In this knitting method, it is therefore possible to increase or decrease stitches and thereby match the shape of the stocking to all existing perimeter variations. Thus, even with extreme edema forms an optimal pressure curve is possible. Flat-knit compression stockings are also dimensionally stable. They do not settle in the skin folds of edema patients, unwanted constrictions are prevented. The massage effect caused by the coarser structure of the flat-knit products on the subcutaneous connective tissue has a positive influence on the contraction of the lymphatic vessels. The higher air permeability and breathability also increase patient compliance.

Another advantage of the flat knit products is that the working pressure - ie the physical pressure that the knitted fabric generates against the movement of the musculature - is much higher. In the case of edema patients, this significantly reduces the risk of re-dematatization. By the way: The prescription of medical compression stockings does not burden your remedy and remedy budget!

1. Medical compression stockings, when worn regularly, have a life of at least six months, i. the patient is entitled to a new prescription every six months.

2. There is no rigid assignment of compression classes to particular diagnoses. All compression classes, and in particular compression class 1, may be prescribed at the discretion of the attending physician as medically necessary.

3. In individual cases, for example if the patient is unable to put on compression stockings of compression classes 3 and 4 alone, the doctor may order two stockings of lower compression classes to be worn one on top of the other.

4. Differentiation is made between circular knit products for the treatment of venous diseases and flat knit products for the treatment of edema. This takes into account the special role of flat knit products in lymphatic care.

The supply of medical compression stockings, Legal advisor for patients

Everything for the therapeutic success of lymphoedema
With compression stockings that look and feel comfortable. Fact is: Only by consistent adherence to the therapy, an aggravation of the disease can be prevented. In the treatment of lymphedema, the Complex Physical Decongestion Therapy (KPE) has proven to be the first treatment phase. It causes z. As the drainage of lymphatic congestion, the restructuring of altered, hardened connective tissue, activating the muscle pumps, etc.

Compression therapy through compression stockings

KKL I (light) 18-21 mmHg
KKL II (medium) 23-32 mmHg
KKL III (strong) 34-46 mmHg
KKL IV (very strong) - over 49 mmHg

The second phase of therapy (KPE Phase II) differs from Phase I, especially in compression therapy. Instead of bandages, the patient now receives special compression stockings, which should receive the Entstauungserfolg. These are usually individual and manufactured in flat knitting technology. Compression supplies are available for arms, hands, legs and toes.

About the compression class (from I to IV) and the type of care decides the attending physician. Modern compression stockings z. They are made of high-tech fibers, are comfortable to wear and have a high air permeability, which benefits the skin very much.

Tips for a successful compression therapy:

Important for the success of the compression therapy is a comprehensive consultation by the doctor and specialist medical trade as well as a correct measurement of the stockings. This takes place at predetermined measuring points.
In order to work properly, compression stockings must fit exactly. Each patient should have the correct dressing and undressing shown exactly and try it several times during initial care. Practical are dressing and undressing aids, which - like the compression stockings - are available from specialist retailers.It is important to pay attention to the care instructions: Only properly maintained compression stockings stay in shape and can ensure lasting therapeutic success.

Contrary to the opinion of the experts, there are no fixed deadlines for the supply of flat-knit compression supplies.
A dual equipment is according to the guidelines (this regulates this legally binding) for medical and hygienic or safety reasons possible. The reasons for multiple equipment must also be named in the recipe, ie replacement supply for hygienic reasons.

Only an AC supply allows own proper use of the stockings, with the daily necessary laundry. The warranty of the hosiery manufacturer is 6 months and guarantees the promised characteristics of the product.

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