Blood pressures, IV's and fingersticks after mastectomy
Dear OncoLink "Ask The Experts,"
As a Certified Nursing Assistant I have always been ordered to not take blood pressures, no finger sticks, no blood draws on the arm of a patient that has had a mastectomy. I can understand not doing it for a certain amount of time, to allow time for healing. However, is that for the rest of the patients life, or is there a set time after the surgery that the arm may be used? Your assistance is greatly appreciated.
Lora Packel MS, PT, Coordinator of Cancer Therapy Services for the Hospital of the University of Pennsylvania, responds:
Many women have their axillary (arm pit) lymph nodes removed when having a mastectomy. Lymph nodes help drain fluid and other cells out of the arm. When a patient has lymph nodes removed, they have fewer "drainage pipes" or pathways for fluid to move out of the arm. This may result in a back up of fluid, which is called lymphedema. Edema means swelling and lymph is the fluid drained through the lymph nodes.
We ask that patients avoid blood pressures, IV's and fingersticks for blood sugar on the side of their surgery for their lifetime. This is to reduce the risk of injury or inflammation to that arm. The body's natural response to injury is to send fluid and infection fighting cells to the area. This results in more fluid in an arm that has fewer "drainage pipes," and MAY result in swelling.
There may be times where an IV is needed in the arm. There is no evidence to state that an IV will cause lymphedema, so we counsel patients to avoid it if at all possible. If there is an emergency, then the risks of lymphedema need to be weighed against the benefit of putting an IV in an "at risk" arm.
Please refer to the other sections on OncoLink which discuss lymphedema in more detail. Also, the National Lymphedema Network has 18 steps to prevention that will detail the precautions we recommend.
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