Myth-busting: IVs, blood pressures, and lymph node dissections

Yes, you can place an IV and measure blood pressure on the side of an axillary lymph node biopsy

Back in the 20th century, when radical mastectomies and extensive lymph node excisions were the standard of care for breast cancer surgery, postoperative lymphedema was common. In an effort to reduce lymphedema, a teaching took hold advising these patients to avoid measuring blood pressure and having IVs placed on the side of the lymph node dissection.¹ One concern was that frequent blood pressure measurements would cause fluid to back up, worsening the lymphedema. Concerns with IVs included the risk of the IV causing an infection or infiltrating. While cellulitis is associated with worsened lymphedema, no evidence supports an association between IV placement and lymphedema. As for an infiltrated IV, this is a problem for anyone regardless of a history of lymphedema.

Modern breast cancer surgery with sentinel lymph node biopsy carries a lower risk of lymphedema of around 3% for a partial mastectomy and up to 8% with a sentinel lymph node biopsy. The incidence of lymphedema increases further if more axillary nodes are excised.²

What should you do?

Ask your patients if they have a history of lymphedema. If they have no history, then it is fine to place IVs and measure blood pressure as you normally would.

Even if a patient has a history of lymphedema in one arm, you can still place IVs in that arm. The majority of the evidence has shown no association between IV placement in the ipsilateral arm and lymphedema. For example, one retrospective study comparing 5,153 IV placements in the ipsilateral arm to 2,743 IV placements in the contralateral arm found no significant difference in the rate of complications.

You can also take single blood pressure measurements on the same side as the lymphedema.

Whether you want to take repeated blood pressure readings on the side of lymphedema, such as would be done under anesthesia, may be a more nuanced topic. While single blood pressure measurements have not been shown to cause or worsen lymphedema, studies have not examined the effects of continuous blood pressure measurements on the incidence of lymphedema. Given that lymph nodes are usually removed proximal to the blood pressure cuff, and given that pressure is often used as a treatment for lymphedema, it seems reasonable to think that cyclic blood pressure measurements would not worsen lymphedema. However, here I cannot offer any evidence-based guidance.³

Let’s put this outdated teaching to rest and assure patients that it is safe to have IVs placed and blood pressure measurements taken on the same side as their prior lymph node excisions even if they have a history of lymphedema.

1. In this post, all discussion of blood pressure measurements refers to non-invasive measurements using a blood pressure cuff.

2. Other factors increasing the incidence of lymphedema include radiation to the lymph nodes and increasing BMI.

3. Anecdotally, when patients have bilateral mastectomies and lymph node dissections, people regularly take arm blood pressure readings without problems.