There seems to be more bilateral mastectomy patients with node dissections. Our team has been adament about not inserting a piv in any arm with node dissection even sentinel nodes. recently the surgeon and anesthesiologist are giving orders to staff to insert piv in mastectomy arms stating there is no contraindication . Does any one have any literature or proven studies to back us up on not placing piv in arm with node dissections. On bil. mastectomy what is the recommended site for venous access. is it acceptable to place piv in arm which has only sentinel node </=3nodes. One MD stated that <5 nodes is acceptable.
It seems this debate does not end! My vascular team is getting pressure (again) from the surgical groups, PA's and anesthesiologists to place lines in patients that have had node discections, or sentinal node biopsies. We currently will not place lines in patients that have had axillary node discections or sentinal node biopsies. Did you ever find any articles, studies, papers to back up your questions? If so PLEASE post the links!
See INS SOP # 27 Site Selection. Several statements and references there. No real "studies" but strong recommendations from ONS and INS to avoid using these arms for venipuncture. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
It is difficult to find studies when using mastectomy and PICC as search terms. Regarding lymph node dissection and VAD insertion or blood sampling the studies are of poor quality or anecdotal in nature. There is a recent review of the literature - Jakes, A., Twelves, C. (2015). Breast cancer-related lymphedema and venipuncture: a review and evidenced- based recommendations. Breast Cancer Research and Treatment, 154:455-461. "Venepuncture in the ipsilateral arm carries a small risk of infection. but there is no robust evidence to support this increasing the risk of subsequent lymphedema and patients should be reassured accordingly."
S Gordon
Check out the statements on this issue from ONS also. Both INS and ONS would be used by experts in a lawsuit to measure your practice. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861