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
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
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.
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
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
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
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.