It has long been accepted that in patients who have undergone axillary lymph node dissection/clearance, the ipsilateral arm must not be used again for any sort of medical instrumentation. This frequently results in overuse of the other arm (and sometimes the feet and other creative sites) for vascular access. The outcome was often impracticality, discomfort, distress, and occasionally overt harm to the patient. All due to the theoretical risk of lymphoedema.
But just just how theoretical is that risk? Very, it appears. Over the past 14 years, the weight of cumulative evidence has shown that there is very little to prove that instrumenting the affected arm increases the risk of lymphedemga.
All of this has caused a recent shift in the clinical paradigm - so much so that the latest guidance in 2023 from The Australian and New Zealand College of Anaesthetists says it is safe to use the patient's affected arm for vascular access, vaccination, BP monitoring.
In fact, ANZCA has a media release and a patient factsheet on this very topic.
In this episode of the podcast, I chatted to anaesthetist Dr James Marckwald to clarify the evidence and context behind this new guidance.
Hooray for medical advancement!
** All content and opinions expressed are those of the host and guest, and do not represent the views of any of the organisations with which they are affiliated.
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