Care of the lower extremities in patients with acute decompensated heart failure

Patients with heart failure and pulmonary edema are often admitted to the critical care unit. Many of these patients have severe peripheral edema, which may be associated with exudates and wounds of the lower extremities and which present a challenge to critical care nurses. Little information is available on treatment of peripheral edema in the intensive care unit or in patients with unstable hemodynamic status. Nursing care is based on available evidence, findings on chest radiographs, and hemodynamic status. Medications that contribute to peripheral edema should be evaluated and discontinued if possible. An appropriate mattress surface with an underpad that promotes wicking away of moisture should be selected. The patient's lower extremities should be elevated according to his or her current pulmonary status, and skin-protective interventions should be instituted. Multilayer compression wraps should be avoided until the patient's hemodynamic status is stable and the patient can get out of bed.