Name two precautions or relative contraindications to consider before performing MLD.

• A. Controlled asthma and seasonal allergies.
• B. Recent travel and dehydration.
• C. Uncontrolled congestive heart failure and acute kidney disease; active skin infection in the treated area.
• D. Low blood pressure.

Answer: (C)

MLD safety hinges on avoiding situations where increasing lymphatic flow or fluid shifts could harm the patient, or where infection could be spread. Uncontrolled congestive heart failure means the heart isn’t handling preload well; boosting lymphatic drainage can increase venous return and the workload on the heart, making it a relative contraindication until the heart is stabilized. Acute kidney disease similarly involves delicate fluid and electrolyte balance; moving fluids more rapidly can worsen kidney distress or cause instability, so it’s avoided in the acute phase. Active skin infection in the treated area is a precaution because massage over infected skin can spread bacteria or irritate the area, delaying healing; the region should be treated only after infection has resolved.

The other listed scenarios don’t carry the same level of risk in typical MLD practice. Controlled asthma and seasonal allergies aren’t contraindications, dehydration and recent travel aren’t standard reasons to withhold MLD, and low blood pressure isn’t a clear, absolute contraindication, though vital signs should always be monitored.