We are in the process of updating our policy, which is old!!!, in regards to venipuncture in the double matectomy pt. I would love something current and possibly published in the U.S. We currently will only stick a pt. if there has been no lymph node removal. There seems to be some debate as to the length of time since the surgery and who is the source saying whether there was node removal or not. This was spurred by the request of a physician to have an iv started in a pt who was 2 wk. s/p double mastectomy coming in with fever and malaise. Unsure of node removal, the nurse declined to start iv in arm but asked if foot was ok for overnight. The MD declined saying he did not want to give vanc that way.