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Alma Kooistra
Biopsy vs dissection

Had an order for a PICC on a patient who had bilateral mastectomies......the first in the distant past with lymph node disection and the second more recently with sentinal node biopsy only.  Initially I recommended a Hohn because of the situation, but the surgeon and internist said OK to do on the side with lymph node biopsy only since IV access in that situation is not contraindicated.  So we did.......  I had never had that sort of discussion and outcome before.  Is there concensus that it's OK to do it on the side that had biopsy only?

We have had to resort to

We have had to resort to using mastectomy arms ibut only if they have been asymptomatic, that's even with lymphnode dissection.  It is a last resort usually.  We have not seen any bad outcomes from this practice.  Of course the risks vs benefits are weighed. 


Sentinal node biopsy would present very low risk of complications.  I think you can feel very comfortable placing a picc in that arm. 


D. Cole, CRNI


Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA


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