Blood pressures, IV's and fingersticks after mastectomy

Last Modified: December 8, 2017

Question:

Dear OncoLink "Ask The Experts,"
As a breast cancer survivor, I have always been told to not have blood pressures, finger sticks, or blood draws on the arm on the side of my 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 my life, or is there a set time after the surgery that the arm may be used? Your assistance is greatly appreciated.

Answer:

Lora Packel PhD, PT, CCS, Department of Physical Therapy, University of the Sciences, responds:

As part of breast cancer surgery, many women undergo removal of some or all of the lymph nodes in their armpit (axilla).  Removal of all lymph nodes is called an axillary node dissection (AND), whereas removal of a limited number of “key” lymph nodes is called sentinel lymph node biopsy (SLNB). In addition, some women receive radiation to their chest wall and armpit after surgery.

Removal of lymph nodes and radiation increase one’s risk for lymphedema, which is an abnormal buildup of lymph fluid. SLNB lowers the risk for lymphedema as compared to AND. To lower your risk for lymphedema, it is recommended to:

  • Know your arm.  It’s normal to have some swelling after surgery, but continued swelling or any new swelling should be reported immediately to your medical team.
  • Have a healthy weight.  Being overweight increases your risk for lymphedema.
  • Avoid cuts/scrapes in the arm on the side of your surgery.  If you do get a cut, wash the area with soap and water and do your best to keep the area clean and free of infection.
  • Exercise.  Improving your fitness reduces your risk for lymphedema and helps you regain strength. Be sure to get approval from your medical team first and seek out a physical therapist who specializes in treating people with cancer.
  • Blood Pressure: Many organizations, like the American Cancer Society and the National Lymphedema Network, advise survivors to avoid blood pressure on the surgery side, if possible. However, there is not strong evidence to support this recommendation.1
  • IV’s: It is recommended that IVs are placed in the arm on the opposite side of your surgery, if possible.  There is limited evidence to show that IVs contribute to lymphedema, however there is evidence that show development of an infection (cellulitis) can contribute to lymphedema.  Therefore, one should request that IVs get placed on the non-affected side, if possible. If there is a need to place an IV on the affected side, work with your medical team to keep the area clean and free of infection.2
  • Read more about lymphedema and risk reduction.

1Bryant JR, Hajjar RT, Lumley C, Chaiyasate K. Clinical Inquiry-In women who have undergone breast cancer surgery, including lymph node removal, do blood pressure measurements taken in the ipsilateral arm increase the risk of lymphedema? The Journal of the Oklahoma State Medical Association. 2016;109(11):529-531.

2Ferguson, CM., Swaroop, MN, Horick,N., Skolny, MN, Miller, CL, Jammallo, LS et al. (2016). Impact of Ipsilateral Blood Draws, Injections, Blood Pressure Measurements, and Air Travel on the Risk of Lymphedema for Patients Treated for Breast Cancer. J Clin Oncol 34(7), 691-8.

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