Is it safe to use the arm on the same side as the mastectomy for Intravenous (IV) therapy?

IV Therapy in the Mastectomy Arm

Using the ipsilateral arm (same side as mastectomy) for IV therapy is safe and appropriate in the absence of lymphedema. The traditional blanket prohibition against ipsilateral arm use is not evidence-based and can lead to unnecessary complications from alternative access sites 1, 2.

Key Clinical Decision Point

The presence or absence of lymphedema—not the mastectomy history itself—determines whether the ipsilateral arm can be used for IV access 3, 1.

When the Ipsilateral Arm CAN Be Used:

• Post-mastectomy patients without lymphedema can safely have IV access in the ipsilateral arm 1, 2
• Post-axillary lymph node dissection patients without lymphedema can safely have IV access in the ipsilateral arm 2, 4
• Post-sentinel lymph node biopsy patients without lymphedema can safely have IV access in the ipsilateral arm 1

When the Ipsilateral Arm Should NOT Be Used:

• Active lymphedema is present in the ipsilateral arm 5, 3
• Known diseases with altered circulation such as superior vena cava syndrome are present 5

Supporting Evidence

The strongest recent evidence comes from a large retrospective study of 3,724 patients with 7,896 IV placements following breast cancer surgery 2. This study found:

• Complication rate in ipsilateral arm: 3.9 per 10,000 (95% CI: 0.5-14.0) 2
• Complication rate in contralateral arm: 7.3 per 10,000 (95% CI: 0.9-26.3) 2
• No significant difference between groups (P = 0.91) 2
• Zero complications in patients with ipsilateral IV placement after axillary node dissection 2

An evidence-based practice project involving over 100 breast cancer patients with lymph node involvement demonstrated zero incidences of resulting lymphedema after allowing ipsilateral arm use for IV access, blood pressure, and phlebotomy 1.

Clinical Algorithm for IV Site Selection

1. Assess for lymphedema: Examine the ipsilateral arm for swelling, heaviness, or clinical signs of lymphedema 5, 3

2. If lymphedema is present: Use the contralateral arm or consider central venous access 5

3. If lymphedema is absent: The ipsilateral arm can be safely used with proper technique 1, 2

4. Apply standard IV insertion precautions 5:

   • Use large veins in the forearm 5
   • Avoid joints 5
   • Use flexible cannulae (not butterfly needles for vesicant drugs) 5
   • Verify blood return before and during infusion 5
   • Monitor insertion site regularly for swelling, pain, or redness 5

Important Caveats

The ESMO-EONS guidelines note that "cannulation on the side of a mastectomy is still a matter of discussion" in the context of chemotherapy extravasation prevention 5. However, this statement reflects historical controversy rather than current evidence, which strongly supports safety when lymphedema is absent 1, 2.

Avoiding ipsilateral arm use without medical indication can lead to 1:

• Inaccurate calf blood pressure measurements
• Unnecessary foot stick blood draws
• Increased need for tunneled central venous catheters
• Patient anxiety and reduced quality of life

Minor complications reported in studies include itching, bruising, and rare infection requiring antibiotics 4, but these occur at similar rates regardless of which arm is used 2.