Risks and benefits of needle use in patients after axillary node surgery

Abstract

Lymphoedema may be triggered by any type of injection. This is not just an issue for the cured breast cancer patient but for any patient who has undergone under-arm (axillary) lymph node removal to any degree for any type of cancer. Standard advice given to patients following axillary node removal is to avoid any injection or blood pressure measurement on the ipsilateral arm. The evidence base in this area is severely lacking. Patients have reported frustration that nurses are not informed of contraindications in carrying out such procedures on patients at risk of developing swelling. This article discusses the current evidence available on the subject of non-accidental skin puncture (NASP) relating to the patient at risk of lymphoedema and provides guidelines for any professionals conducting such procedures for patients with a history of cancer. The results from a small audit of the guidelines are cited and they reveal that out of 14 patients who underwent NASP procedures in the at risk arm, no patients reported swelling to that limb within a month of these procedures.

Acupuncture for Treatment of Arthralgia Secondary to Aromatase Inhibitor Therapy in Women with Early Breast Cancer: Pilot Study

“…Previous acupuncture guidelines on breast cancer recommended avoiding needle use in the risk or affected area to reduce the possibility of introducing infection or exacerbating lymphoedema. 38 However, this guideline was controversial because it limits the potential effectiveness of the acupuncture treatment on patients with cancer. Findings from recent studies including our study suggest that use of acupuncture in risk or affect areas is safe when the treatment is performed by a qualified acupuncturist.…”

Breast cancer-related lymphoedema risk reduction advice: A challenge for health professionals

“…18 The findings of this prospective study support largely anecdotal findings from previous authors. 67,68 Indications from this small evidence-base prompted Cole 69 to advise against blood pressure measurement, subcutaneous and intramuscular injection and other clinically occur-ring non-accidental skin puncture wherever possible.…”

Borstkanker

“…Venapuncties in de (lymfoedemateuze) ipsilaterale arm na mammacarcinoom worden ontraden vanwege de kans op infecties, maar als zij onvermijdelijk zijn, kunnen zij uitgevoerd worden met extra desinfecterende maatregelen. 20 Er is evenmin een contra-indicatie voor het meten van de bloeddruk aan een arm met lymfoedeem. Bij ernstig lymfoedeem zal de uitkomst echter onbetrouwbaar zijn.…”