LLE Certification

LLE Application Process

LLE Examination Handbook

The NAWCO® off
ers the “Lymphedema Lower Extremity (LLE) Certification Examination” to measure the academic and technical competence of eligible candidates in the area of Lymphedema Lower Extremity Management.

Eligibility for Certification

Applicants for the NAWCO LLE certification must meet all of the following criteria:

  1. Active unrestricted license as a Registered Nurse, Licensed Practical/Vocational Nurse, Nurse Practitioner, Physical Therapist, Physical Therapist Assistant, Occupational Therapist, Physician or Physician Assistant.
  2. Documentation of active involvement in the care of wound care patients or in management, education or research directly related to wound care while actively licensed for at least two (2) years full-time/four (4) years part-time within the past five (5) years.
  3. Completion of application and required supporting documentation
  4. Payment of required fees
  5. Successful graduate of NAWCO approved “Lymphedema Lower Extremity Management Certification Training Course”
  6. Receive a passing score on the NAWCO LLE Examination

NAWCO Approved Lymphedema Lower Extremity Certification Training Courses

Lymphedema & Wound Care Education, LLC

LWCE offers the Lymphedema Lower Extremity (LLE) Certification training on multiple dates and various locations all around the United States.


Upon successful completion of the Lymphedema Lower Extremity Certification examination, candidates may use the initials LLE Lymphedema Lower Extremity Certified, to designate their status. Credentials are awarded for a five (5) year period following obtaining a passing score on the examination. Upon expiration of credentialing term, LLE's are required to recertify with the NAWCO to maintain their credentials.

Scope of Practice

The LLE provides direct patient lymphedema and edema care in acute, outpatient, long-term care and home care settings. The LLE plays an important role as a direct care provider, educator and resource for optimum patient outcomes in lymphedema and edema management associated with wounds. The LLE scope of practice is performed in accordance with legislation code as determined by each respective professional state regulatory board.<
Lower extremity lymphedema and edema management includes the identification, assessment, management, prevention, and continuing evaluation of patients with signs and symptoms of swelling related to lymphatic and or venous failure, which includes but is not limited to primary lymphatic dysplasia and all other forms of secondary lymphatic trauma.

Lower extremity lymphedema, edema and wound management are specialized areas that focus on overall skin care and promotion of an optimal wound environment through reduction of edema and lymphedema. This therapeutic approach includes intensive rehabilitative interventions followed by education in self-care measures to prevent disease progression.

The management of lower extremity lymphedema and edema management requires the skills of the interdisciplinary team that includes the physician, nurse, LLE, dietitian, physical therapist, occupational therapist, social worker, and other health care disciplines or providers depending upon each individual patient assessment. The physician or other advanced practice provider is the leader of the interdisciplinary care team. As such, Lymphedema Lower Extremity and edema management care plans must always be prescribed by the physician or other advanced practice provider.

Content of Examination

The LLE Certification examination is an objective, multiple choice test consisting of up to 100 questions with a total testing time of two (2) hours.

The questions for the LLE Certification examination are prepared by teams of Subject Matter Experts (SMEs). The examination questions are written to assess cognitive levels of knowledge, comprehension, application and analysis related to Lymphedema Lower Extremity Management.

References for Study

The following reference list may be helpful in preparing for the examination. This list does not attempt to include all the acceptable references available, nor is the examination based solely on these sources. The NAWCO does not sponsor or endorse any one reference over another. Some of the references can be accessed online, while others are available at local book stores.
  1. Braunwarton, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s 15th edition Principles of Internal Medicine. 2001. MacGraw hill. NY;NY.
  2. Foldi E, Foldi M, Clodius L. The Lymphedema Chaos: A Lancet. Annals of Plastic Surgery Vol 22; 6. June 1989. Pp 505-515.
  3. Gary D. Lymphedema diagnosis and management. J. Am Acad of Nurse Practitioners. 2007. Pp 72-78
  4. Holcomb, S. Identification and Treatment of Different Types of Lymphedema. Advances in Skin and Wound Care. March 2006. Lippincott Williams and Wilkins. Pp103-108
  5. Kloth L, McCulloch J. Wound Healing Alternatives in Management 3rd edition. 2002 F.A. Davis Co.Phliadelphia
  6. Lerner R, Chang J. Textbook of Angiology. Springer 2002 pp1227-1235.
  7. Linnitt N, Davies R. Fundamentals of compression in the management of lymphoedema. Brit J. of nursing Vol 16 No 10. 2007 Pp 588-590.
  8. McCann M, Ovens L, Louison P, Elliott V. Mixed lymphovenous oedema with leg ulceration: a case study. The lymphoedema Supplement. Oct 2006. Pp 516-519.
  9. Tiwari A, Cheng K, Button M, Hamilton G. Differential Diagnosis, Investigation, and Current Treatment of Lower Limb Lymphedema. Arch Surg. 2003; 138. Pp 152-161.
  10. Valencia I, Flalbella A, Kirsner R; Eaglstein W. Chronic Venous insufficiency and Venous Leg Ulceration. J. Am Acad Dermatol. 2001, Miami Florida pp401-421
  11. Williams A, Vadgama A, Franks P, Mortimer P. A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. European J. of CA care, 2002, 11, Pp 254-261.
  12. Norton School of Lymphatic Therapy; CDT Certification Course Manual 2011
  13. Bergan, J. & Pascarella, L. (2006). Varicose veins: Chronic Venous Insufficiency. In Moore, Wesley S., Vascular and Endovascular Surgery: A Comprehensive Review (7th ed.) (pp. 857-868). Philadelphia, PA: Saunders Elsevier.
  14. Calianno, C. & Holton, S. J. (2007). Fighting the triple threat of lower extremity ulcers. Nursing, 37(3), 57-64.
  15. Damsky Dell, D. & Doll, C. (2006). Caring for a patient with lymphedema. Nursing, 36(6), 49-51.
  16. Day, M. W. (2003). Recognizing and managing DVT deep vein thrombosis. Nursing, 33(5), 36-42.
  17. Foldi, M., Foldi, E. & Kubik, S. (Eds.). (2003). Textbook of Lymphology: for Physicians and Lymphedema Therapists. San Francisco, CA: Urban & Fischer.
  18. Foldi, M., Foldi, E. & Strobenreuther, R. H. K. (Eds.). (2007). Foldi’s Textbook of Lymphology: for Physicians and Lymphedema Therapists (2nd ed.). Philadelphia, PA: Mosby Elsevier.
  19. Frey, B. J. (2009). Varicose veins: Today’s treatment tools. Advance for Nurse Practitioners. 17(6), 49-51.
  20. Galvan, L. (2005). Assessing venous ulcers and venous insufficiency. Nursing, 35(11), 70.
  21. Greenfield, L. J. (2006). Venous Thromboembolic Disease. In Moore, Wesley S., Vascular and Endovascular Surgery: A Comprehensive Review (7th ed.) (pp. 845-856). Philadelphia, PA: Saunders Elsevier.
  22. Kelly, D. G. (2002). A primer on lymphedema. Upper Saddle River, NJ: Prentice Hall.
  23. Koo, L.W., Reedy, S. & Smith, J. K. (2010). Patient history key to diagnosing peripheral edema. The Nurse Practitioner , 35(3), 44-52.
  24. Leskovec, N. K., Pavlovic’, M. D. & Lunder, T. (2008). A short review of diagnosis and compression therapy of chronic venous insufficiency. Acta Dermatoven APA, 17(1), 17-21
  25. Rooke, T. W., Shepherd, R. F. J. & Felty, C. L. (2006). Lymphedema. In Moore, Wesley S., Vascular and Endovascular Surgery: A Comprehensive Review (7th ed.) (pp. 869-875). Philadelphia, PA: Saunders Elsevier.
  26. Sieggreen, M. (2006). A contemporary approach to peripheral arterial disease. The Nurse Practitioner, 31(7), 14-25.
  27. Sieggreen, M. Y. & Kline, R. (2004). Arterial insufficiency and ulceration: Diagnosis and treatment options. The Nurse Practitioner, 29(9), 46-52.
  28. Stephens, Thomas, “Compression Bandaging in the Treatment of Venous Leg Ulcers,”
  29. a. http://www.worldwidewounds.com/1997/september/Thomas-Bandaging/bandage-paper.html
  30. Weissleder, H. & Schuchhardt, C. (Eds.). (2008). Lymphedema: Diagnosis and Therapy (4th ed.). Viavital Verlag GmbH: Essen.
  31. Werchek, S. (2010). Diagnosis and treatment of venous leg ulcers. The Nurse Practitioner, 35(12), 46-53.
  32. Wound Care Education Institute. (2009). Skin and wound management course: Seminar Workbook. Wound Care Education Institute: Naperville, IL & Geneva, WI.

Examination Disclosure

The examination questions remain solely the property of the NAWCO. These materials are confidential and are not to be shared with any person or agency for any reason.

Review of Examinations

For security reasons, examination materials are not available for review. Neither the testing corporation nor the NAWCO will discuss specific questions on any of the examinations. Comments about questions should be directed in writing to the NAWCO Certification Committee. The NAWCO will review comments relating to the exam but will not make a written response to comments.


NAWCO strictly protects the security of your personal information and honors your choices for its intended use. We carefully protect your data from loss, misuse, unauthorized access or disclosure, alteration, or destruction. Though we make every effort to preserve user privacy, we may need to disclose personal information when required by law wherein we have a good-faith belief that such action is necessary to comply with a current judicial proceeding, a court order, or legal process. Otherwise, your personal information is never shared outside the company without your permission. Inside the company, data is stored in password-controlled servers with limited access

Retesting Policy

Candidates who take the LLE Certification examination and are unsuccessful may retake the examination for a total of three additional re-examination attempts within two years of the first examination date. After either four attempts or two years, whichever comes first, you would be required to wait for a period of one year prior to taking the exam again.

If you are unsuccessful in passing the examination, you will receive instructions and a re-examination application by email from the National Alliance of Wound Care and Ostomy.

Candidates are encouraged to self-study or attend a Lymphedema Lower Extremity Management training course during this time. After the one year waiting period, you would be required to reapply and meet all eligibility requirements in order to retake the examination. Unsuccessful candidates are not eligible for any refunds.


Individuals may appeal decisions regarding eligibility, examination results, and disciplinary matters made by the NAWCO certification program by submitting a written letter of appeal to the NAWCO Certification Committee within 30 days of the NAWCO decision or action that is being appealed. Certificants may request a copy of the appeal policy by contacting the NAWCO office.

Certification Certificate

The NAWCO will award an official numbered certificate to all candidates upon passing the NAWCO LLE Certification examination, denoting status as LLE Lymphedema Lower Extremity Certified.


Certification is awarded for a five (5) year period following successful passing of the examination. Upon expiration of the credentialing term, LLEs are required to recertify with the NAWCO to maintain their credentials. LLEs may recertify by examination, training, continuing education or by the Continuing Education & Outreach Program (CEOP). Details of the options will be mailed to successful candidates within one year of expiration of credential.