starting IV on same arm as a mastectomy

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Hey guys, I have been lurking on this page for awhile, but never join. Today I want some input on this topic. I'm just really worried now.

The patient is a DNR patient on peritoneal dialysis. Patient also has active pneumonia. Infectious disease physician has order IV antibiotics on patient for the previous 2 days. Patient is a hardstick. None of the previous nurses or supervisors was able to start an IV on patient. Got report from previous shift nurse that patient has IV antibiotics ordered, but no one was able to start an IV. Well I managed to start an IV on her left forearm with her daughter at bedside. Her daughter didn't say anything, just told me I did a great job and was able to start an IV where other nurses wasn't able to. In morning report from oncoming supervisors. The morning supervisor suddenly told me the patient has a history of left mastectomy! I was so angry and horrified at the same time. No one told me patient has a history of left mastectomy. It was my first day with the patient. She only had a DNR bracelet. No limb alert bracelet.

Then the supervisor told me that patient's daughter told him that she had the mastectomy over 20 years ago, and she said it was OK to start IV on that arm, but he wasn't able to. I'm thinking why the hell he didn't tell me that in the first place. I went to the patient's room and clarify it with the patient's daughter. She did say her mom had it over 20 years ago, and that it was OK to start the IV there.

What I learn in nursing school is that it is not ideal to start IV on same side as a mastectomy. However, this patient needs the medicine. I'm just overly worry guys.

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Specializes in Oncology, OCN.

Did they take the lymph nodes or not? My understanding, nursing student here, is the concern of lymphedema. Also if it was 20 years ago and she's had not lymphedema issues it's probably fine. It's usually just policy to not use the arm on the side of a mastectomy even if there was never an issue. During my clinical last semester I worked with a pt with a history of mastectomy on the left and some issue on her right arm I can't recall. We took her BP on her leg. She lives in a nursing home and said they used her arm all the time with no problem, we still used her leg per policy.

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Specializes in ICU / Urgent Care.

Deep breaths, you're going to be okay.

Stay vigilant for lymphedema is the only tip that comes to mind.

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The thing I was just so mad was that there was no report not to start IV on left arm, no limb alert. Supervisor didn't tell me anything. Another supervisor told me that patient daughter usually tell nurses and phlebotomist to use the other arm. The daughter didn't tell me anything. Then after I found out, I clarify with the daughter. SHe said it was ok since her mom had it over 20 years ago. If I would of known... I'm just scared now.

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Specializes in ICU, LTACH, Internal Medicine.

There is no scientific evidence that placing peripheral IV on the same side as mastectomy (radical or otherwise) after 20 years can cause lymphedema or any other complication if these complications did not develop within first 5 years after surgery. For the first 5 years, data is mixed.

"Never place an IV on mastectomy side, doesn't matter what because it is unsafe" is one of old wives' tales which are still taught in nursing schools despite of being disproved for decades. Relax.

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Specializes in Critical care.

You are fine. I've had patients like that too. It has to do with lymph node removal.

What really concerns me is that it sounds like the patient went 2 days without their IV antibiotics. If so a tunneled catheter. Picc, or some other type of central line should have been placed.

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A surgeon in our same day ambulatory surgery center, her area of expertise is mastectomies, breast cancer, etc., said the same arm is ok.

Even if lymph nodes were removed but there was no other reasonably easy alternative. A clean "sterile" IV insertion is not going to an issue.

A "dirty" cut, scratch, wound, in the affected arm is the bigger concern.

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Specializes in ER.

If its a needed med, start the IV wherever you can get one, but keep looking for a more appropriate site. And get an order to use your site in the meantime.

I agree that they should have told you about the mastectomy. But if that's your only site that will work, that's what you have to use. (with an order)

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Specializes in Trauma, Teaching.

I had a double mastectomy.... and do have mild lymphedema on the right side where they took 11 nodes. Nobody but nobody gets near that arm. But my other arm is fine, only one node out (since it was negative they didn't have to go farther). My oncologist says that side can do whatever, not to worry about BP or blood draws.

If I couldn't use the left for all my follow up labs etc., I would either be constantly stuck in the foot (no thank you very much), or an EJ (for labs?!?!), or had to keep an uncomfortable port for years. I keep a wrist cuff anyway, for my own paranoia, and usually ask labs to be done in the hand; but again, not really necessary.

Starting an IV on the side with all the nodes out, is not so much the IV as the possibility of infiltration. I have a hard enough time controlling drainage (physical therapy, suction cupping, and always a compression sleeve), that I would have major problems dealing with infiltrated IVF. I know it doesn't happen that often, but I have seen some major swelling in an infiltrated arm before.

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Specializes in Case manager, float pool, and more.
canoehead said:
If its a needed med, start the IV wherever you can get one, but keep looking for a more appropriate site. And get an order to use your site in the meantime.

I agree that they should have told you about the mastectomy. But if that's your only site that will work, that's what you have to use. (with an order)

My thoughts exactly. Get order to start IV on that arm as a CYA. I do if at all possible avoid using the arm if they have had a mastectomy but sometimes there are extenuating circumstances.

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I've had a patient who refused to let us take her blood sugar out of the finger on her side of a mastectomy 20 years ago... insert eyeroll...

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Did her medical history in the chart indicate the mastectomy? When you went in did you ask family members or the patient herself if she could have blood pressures, or IV's on that arm?

I take alot of things I hear in report with a grain of salt until I confirm them with my own eyes/ears. I've gotten report several times on patients that stated patients had good csm in both feet only to discover they were missing one. Before starting an IV on a mastectomy patient.s affected side, I would not go by what the family said, I would page the team and ask if it was ok to use that side. I've had similar situations with poor access, and have had to start an IV on the affected side but its uncommon and I don't do it without a doctors blessing, irregardless of what the family says. jmho.

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