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Insertion of PICC lines in patients with a bilat mastectomy

As a new PICC nurse, I had a patient with a bilateral mastectomy who stated she has lymph node involvement. In training, a mastectomy was a contraindication for PICC placement. The surgeon that performed the mastectomy was consulted and said the patient only had sentinal node involvement on the right side, and axillary node involvement on the left, thus it was okay for PICC placement in the right extremity due to no risk of lymphedema.

As a PICC nurse does this go against our standards of practice? I have yet to find evidence based research on this topic. Any suggestions?


Heather Nichols
What about the patient?

   With all of the other catheter options, would it not be more beneficial for the patient you speak of to have a different catheter placed to avoid any possible risk of comlications?  I find that I do not trust surgeons much when it comes to vascular access.  I do not do surgery, so they should not try to be a vascular access specialist unless that is a specilty they are currently working in. 

   I would further assess your patients needs for access.  What is to be infused now, her need for access in the future, her diagnosis, her ability to care for the catheter herself at home (if it is to go home), and how SHE feels about the situation.  Explain ALL of her options to her.  It is about her wants and needs, not the surgeons.  His job was done when she rolled out of the OR. Sometimes the standards do not go that far, so we just need to use our own wonderful critical thinking skills, and do what is best for our patients.  You usually will not go wrong if you do.

Thank you for your reply. In

Thank you for your reply.

In this case, the patient needed a power line for a CT scan. The surgeon was going to place a power central line, but was not available in our facility.

Why other catheter options weren't looked into?

The only research I have found is that there is a risk for lymphedema with sentinal node involvement, but a less risk.

What did we do before power lines.......

Gwen Irwin
Insertion of PICC lines in patients with a bilat mastectomy

In the past a bilateral mastectomy had a different meaning.  Today, a bilateral mastectomy might not at all involve lymph nodes.

We question the type of mastectomy.  We are learning more and more.  If there are lymph nodes removed, we definitely want to know more information.  We do question the surgeon about the risk for lymphedema.  Compared to years past, the surgical intervention is not as radical and doesn't place the patient at as much risk for lymphedema.

We are finding more patients that aren't at risk for lypmhedema from their mastectomy.

Gwen Irwin

Austin, Texas

Gina Ward
Risk for lymphedema


Could someone clarify how to assess the risk for lymphedema.  Is it a specific number of lymph nodes affected?,  or if any at all were removed.  Some times I have heard people say it has been over 10 years so it is ok. 

What surgically are they doing now that decreases the risk of lymphedema? 


I appreciate all input in this area. 

Gina Ward R.N. CPAN

Gina Ward R.N., VA-BC

Donna Fritz
new techniques

Lumpectomies and sentinel lymph node (SLN) removal are much less invasive than the modified radical mastectomies and axillary lymph node dissections (LND) of yesteryears.  For sentinel lymph node identification, dye and a radioisotope are injected periareolar and then the tracking of the radioisotope is done in imaging.  Once identified, pt taken to OR for lumpectomy and removal of this one node (or maybe two if they are close).  The dye allows the surgeon to visualize it, although a radiation detection device is also used to identify the "hot" node.  This node is examined in much more detail by pathologist than if several nodes are taken in a more traditional LND--finer "cuts," more rigorous inspection.  There is a higher risk of lymphedema with more invasive surgery and more therapies.  (Many LNDs are done with only "level I" nodes removed.)  Radiation to nodes, especially, and chemotherapy can increase risk of lymphedema in the extremity.  Generally, if pt has lumpectomy, the standard is also breast radiation.  Lumpectomy + radiation is equivalent to mastectomy in smaller breast cancers, but nodes are usually not radiated if SLN was negative.  Risk/benefit must always be considered when thinking about PICC lines in these pts.  Not sure we have enough data to really assess whether PICCs in the extremities of lumpectomy and SLN pts cause any problems or an increase in lymphedema.  Sounds like fertile ground for a study.

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