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lrichardson
Emergent IV access in mastectomy patients

I just joined so please excuse me if this has been addressed recently.  What is the current practice on IV access in the emergent setting (specifically pre-hospital) for patients with a history of mastectomy?

 

Respectfully,

 

Lee Richardson

EMS Education Coordinator

Duncanville (Texas) Fire Rescue

lynncrni
Do not use the side of a

Do not use the side of a mastectomy for venipuncture - from both INS and ONS. Lymphedema can result. In the case of bilateral mastectomy, try to learn if there were lymph node dissection on one side, then avoid using that side. The side with lymph node dissection has the greatest risk for lymphedema.

The same would be true for patients with any type of paralysis on one side. That side must be avoided. The paralysis will negatively affect normal blood return. Venipuncture will compromise the circulation further. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Bill Jansens
To add another point

To add another point of consideration from an oncology perspective, if someone has had bilateral mastectomies and bilateral lymph node removal, then you ask whether they have had radiotherapy to their axilla on either side. Radiotherapy to the axilla increases the risk of developing lymphoedema considerably. 

ann zonderman
As I note the poster is from

As I note the poster is from the  EMS practice.... and asked for guidance in an emergent situation.... I would want to consider the gravity of the need for the IV access at the emergency.  If it is a life or death situation... there woiuld be additional factors to consider besides the history of the mastectomy. 

 

Ann Zonderman, BSN, JD, CRNI

lynncrni
I do agree with Ann on this

I do agree with Ann on this issue. Saving a life takes precedence over the risk of lymphedema. However, I have to add that the basic principles of peripheral venipuncture can not be overlooked when there is no life or death situation. I review many legal cases where the complications started while the patient was receiving emergency care. Not all situations in the pre-hospital care or ED care are actually life-threatening. In many of them there is time to do a complete assessment of these and other risks. When these risks are not assessed or even briefly considered, the liability of the healthcare worker skyrockets. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

gmccarter
IO?

I don't do IO access, but from my reading this seems like a good time to try that. There was a recent article in, I believe, JIN, that was about using IO in the ICU as well as ER.

Gail McCarter, BSN,CRNI

Franklin, NH

janicer
Emergent IV in Masectomy Patients

This is applicable not just masectomy patients but also to anyone who has had an axillary lymph node resection.  I had a patient once who I did a lot of teaching with related to precautions and lymphedema and then the surgeon came in and said that was nothing she had to worry about-just to forget it since she hadn't had a masectomy.  As a long term Oncology nurse it was frustrating to say the least.

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