Have you had axillary lymph nodes removed during breast surgery?

Patients who have undergone axillary surgery have traditionally been advised to avoid having the arm on the affected side used for medical procedures because it was thought this might contribute to the occurrence of swelling known as lymphoedema. This is a complication that may arise following axillary surgery, including sentinel lymph node biopsy, targeted axillary dissection, and axillary clearance. However, clinical evidence shows this is not the case and that the arm on the affected side can usually be safely used for medical procedures.

In fact, in many circumstances, using the arm on the affected side can be better for patient comfort and safety, because:

Relying solely on the blood vessels in unaffected arms can result in damage through overuse, and cause discomfort.
While using lower limbs for the procedures listed below may be an option, this can result in a less accurate measurement of blood pressure.

What procedures does this advice cover?

It applies to common medical procedures performed by anaesthetists and other health care professionals on patients’ arms, including:

Taking blood.
Administering and delivering medication via an intravenous (IV) drip.
Performing anaesthesia monitoring such as invasive and non-invasive blood pressure monitoring.

I don’t have lymphoedema (swelling) in my arm. Is it safe to use for medical procedures?

If you have had your axillary lymph nodes removed and do not have lymphoedema, the arm(s) may be safely used for the medical procedures listed above. Your health care professional will discuss this with you.

I have lymphoedema in my arm. Is it safe to use for medical procedures?

If you have pre-existing swelling, your arm can still be used. Any decisions in this regard will be guided by your healthcare professional, who will discuss any other options and advise on the most suitable one for you.

Where can I find more details?

Appendix A in ANZCA’s professional document on anaesthesia monitoring, PG18 (A): Guideline on monitoring during anaesthesia, includes more detail about the safety and comfort of using arms affected by axillary surgery.

ANZCA acknowledges the contribution of: Associate Professor Victoria Eley – PhD, FANZCA (Expert – Lead); Professor Christobel Saunders, AO, FRCS, FRACS; Associate Professor Pierre Bradley, FANZCA; Ms Joanne Lovelock, Breast Care Nurse Clinical Lead TAS VIC; Ms Rebecca James, Consumer representative; and Dr Peter Roessler, FANZCA, ANZCA Director of Professional Affairs (Professional Documents).

Please note: This information is a guide and should not replace information supplied by your anaesthetist. If you have any questions about your anaesthesia, please speak with your treating specialist.