Can I get your opionion(s) once and for all on this topic. A non-emergent patient with recent bilateral mastectomies and lymph removal (unable to determine how extensive) requires an IV to go to radiology for port placement. It would be very short term and would only receive whatever pain/sedation meds are used in IR for the procedure. An EJ was attempted and failed. What is our best option for this patient?
Thanks,
Kristi Selck, RN, BSN
There is no much published evidence to use for this decision. Here is one publication available after we finished the literature review on this issue for the INS Standards.
After axillary surgery for breast cancer--is it safe to take blood samples or give intravenous infusions?
Winge C, Mattiasson AC, Schultz I.
Division of Surgery, Department of Clinical Sciences, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden.
Abstract
AIM:
To investigate the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer.
BACKGROUND:
After axillary lymph node clearance in patients with breast cancer, some women experience lymphoedema and recurrent infections. To reduce the risk of these postoperative complications, most women are advised to not have intravenous infusions in, or blood samples taken from, the arm in the operated side. Very little published data are available regarding the incidence of lymphoedema after intravenous procedures under clean conditions in the hospital setting. This study set out to investigate the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer is therefore important.
DESIGN:
Descriptive.
METHODS:
Self-reported questionnaire.
RESULTS:
Most of the reported complications were minor, including itching, bruises and vomiting at the time of the intravenous procedure. The most serious complication was infection in one patient needing antibiotic treatment and subsequent arm swelling.
CONCLUSIONS:
This study indicates that if a blood sample is taken or intravenous injection is given according to the current Swedish guidelines for health care professionals, there should be a very low risk of complications.
RELEVANCE TO CLINICAL PRACTICE:
If intravenous procedures are performed without any disadvantage in the arm of the operated side in women who have undergone axillary surgery, the clinical problem of finding a proper vein and the psychological concern of the women can be reduced.
I would need to read the entire publication but this might provide some guidance. You may have to go with a common sense approach based on your assessment of each patient. Were the axillary dissections different on each side? Which side was the least invasive? Is there currently any signs of lymphedema? What other risk factors does this patient have for venipuncture in the feet? Hypercoaguable? Then weigh these risk vs benefit to decide for each patient. 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