When can an intravenous (IV) line be placed in the arm on the same side as a breast cancer diagnosis?

From the Guidelines

Intravenous (IV) lines should be avoided in the arm on the same side as a breast cancer diagnosis due to the risk of lymphedema, and alternative access sites should be used whenever possible. This recommendation is based on the potential for compromised lymphatic drainage following breast cancer surgery, which may involve lymph node removal or radiation, as noted in the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of primary breast cancer 1. The guidelines advise against cannulation, venesection, and blood pressure monitoring in the ipsilateral arm after axillary clearance to minimize the risk of lymphedema, which can affect up to 40% of women when axillary clearance is combined with radiotherapy to the axilla.

Some key considerations for IV placement in patients with a history of breast cancer include:

• Avoiding the affected arm for IV placement whenever possible to reduce the risk of lymphedema and other complications
• Using alternative access sites, such as the contralateral arm, for IV placement
• Documenting the rationale for IV placement on the affected side, if necessary, and removing the IV as soon as possible
• Placing IVs as distally as feasible, such as in the hand rather than the antecubital fossa, to minimize trauma to the affected arm
• Informing healthcare providers about the patient's breast cancer history to ensure appropriate IV placement decisions, as the risk of lymphedema persists indefinitely after breast cancer treatment 1.

From the Research

IV Placement in the Arm on the Same Side as Breast Cancer Diagnosis

• The placement of an intravenous (IV) line in the arm on the same side as a breast cancer diagnosis is a topic of interest, with some studies investigating the risks and benefits associated with this practice 2, 3, 4, 5, 6.
• A study published in 2021 found that the frequency of complications was not significantly different between IV placements in the ipsilateral and contralateral arms, suggesting that avoidance of IV placement in the arm ipsilateral to breast cancer surgery may not be necessary 2.
• Another study from 2010 investigated the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer, and found that most reported complications were minor, with a low risk of serious complications 3.
• A 2006 article discussed the current evidence available on the subject of non-accidental skin puncture relating to patients at risk of lymphoedema, and provided guidelines for professionals conducting such procedures, highlighting the lack of evidence base in this area 4.
• A 2019 study evaluated complication rates between central venous ports placed ipsilateral versus contralateral to the breast cancer, and found no difference in port complications or lymphedema rates by location 5.
• A 2012 study investigated the construction of autogenous hemodialysis access in the ipsilateral arm after axillary dissection for breast cancer, and found that it did not seem to contribute to lymphedema development, suggesting that physicians should not oppose the use of the ipsilateral arm if it is the only arm with suitable vasculature 6.

Key Findings

• The risk of complications associated with IV placement in the arm on the same side as a breast cancer diagnosis is low 2, 3.
• The evidence base for avoiding IV placement in the ipsilateral arm is lacking, and some studies suggest that this practice may not be necessary 2, 4, 6.
• The use of the ipsilateral arm for IV placement or other medical procedures may be considered on a case-by-case basis, taking into account individual patient factors and medical history 5, 6.