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Fri, 08/17/2007 - 00:58

DENISE123

mastectomy patients

Does somebody has the INS book of standards close by that can answer a question?Â We never use a mastectomy arm on a patient unless its absolutly necessary and that requires a doctors order.Â Â However when the patient has had a double mastectomy 10-15 yrs prior some feel its not necessary to call the md, but just to document its placement and to do careful monitoring.Â Since I don't have a copy of the standards would someone see if it says anything about double mastectomies.Â thanksÂ DeniseÂ ([email protected])

Fri, 08/17/2007 - 08:10

lynncrni

No the INS standards do not

No the INS standards do not address patients with double mastectomies and the standards are not that "prescriptive" with exact specifics for each situation. My opinion would that that a physician's order is required regardless of the situation, although you may have to use an arm that has had a mastectomy. Your assessment and conversation with the physician should include such factors as the presence of any lymphedema now or in the past, the specific type of surgery, was lymph nodes involved, etc. Choose the side with the least risk based on this information. 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

Sun, 08/19/2007 - 02:41

Nadine Nakazawa

The problem is if axillary

The problem is if axillary lymph nodes were removed. It does not matter whether they were removed a year ago or 25 years ago. It's the lymph node removal. The risk is permanent lymphedema. I strongly recommend a "small bore tunneled catheter". It can be a PICC line or Hohn catheter, placed by IR in the internal jugular vein with a small tunnel and exiting just below the clavicle. Avoid the arms altogether. Nadine Nakazawa

Nadine Nakazawa, RN, BS, VA-BC

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