Measuring Nonpitting Edema?

[RN3688]

I'm a new clinical instructor and as I was checking my student's charting today I noticed that they would just chart "Nonpitting edema." I explained to them that they needed to have some sort of a measurement with it so you could tell if it was getting better or worse. I told them how to do it using a 1+ to 4+ system, but as I was explaining it... it didn't make any sense to me. I started doing some research and realized that the 1+ to 4+ system only applies to pitting edema... So, my question is... how do you measure NONPITTING edema? I mean... there has to be a way because you'd want to assess if it is getting better or worse, right? Please help so I can help my students understand! (as well as myself!)

[Student Mom to Three]

Couldn't you just measure around the extremity at its widest point??

[Caffeine_IV]

You can't grade it in the same way because the scale is for the depth and how long it stays indented.

If anything, you could measure the circumference of the extremity to see any improvements or worsening of the edema.

[JustBeachyNurse, LPN]

You measure the circumference of the affected body part. Often marking the place with a surgical skin marker to have consistency in site measured.

[iluvivt, BSN, RN]

You also can compare it to the other limb. This is particularly useful if it is unilateral.

[toomuchbaloney]

I was taught to measure the extremity with nonpitting edema, marking it so that you measure from the same spot. It has served me well for almost 4 decades.

[la_chica_suerte85, BSN, RN]

The only solution that comes to mind is measurement of the circumference of the extremity. I did a CE on snakebites and, since the edema around the wound is nonpitting, measurements are required to determine if it is getting worse or better (this process is, of course, more complicated than dependent edema or angioedema). So, they need to bust out the tape measure and get some cm values going. Like toomuchbaloney mentioned marking it so you ensure accuracy in measuring the same spot (you can also note if the mark is migrating away or towards a landmark for improving or worsening edema -- but again, that is more for the snakebite assessment).

[nurseprnRN, BSN, RN]

I always like to ask students, "Why do we care?" Why do we care about edema? What does it tell us? How do we know?

You know what? This is your golden opportunity to teach them about fluid retention and daily weights. When someone is bedbound, edema is spread into all dependent tissues-- that is, all of the ones next to the mattress, not just the feet and legs. It's pretty meaningless to quantify edema in a localized area to guide therapy. (Exceptions, e.g., lymphedema in one extremity, or the above-mentioned snakebite, or other uni-limb problem, in which case you compare a measurement to yesterday's in the same place)

Explain that some estimates say you have to be 8-10 liters over dry weight to show edema at all, that you teach pts to do their daily weight first thing in the morning with an empty bladder and before taking anything PO and to report any gain of >2 lbs overnight, and that they should use that same routine with all patients.

Daily weights: THAT''s what drives therapy, because that's what affects/causes CHF, looks at increasing ascites (that's easy to measure qd with a tape measure), or looks at recovering dehydration.