Question: PICC insertion on patient with history of mastectomy, especially with lymph note involvement?

It has always been standard of practice that we, as nurses, would not do venipuncture in mastectomy arms for even peripheral IV’s, much less PICCs. I would like to know your recommendation for placing a PICC in a mastectomy arm.  Lymph node dissection being a factor vs. no lymph node involvement, as well. What is best practice according to PICC excellence guidelines? R.L 2/8/18

Answer: Nothing has changed, patients with a history of mastectomy, esp with lymph node involvement, should not have intravenous devices in the peripheral veins of that arm. These patients have impaired blood flow, potential nerve involvement and a higher risk of complications. I do occasionally hear a physician ordering PICCs anyway. The best approach is to discuss the contraindication directly with the MD and if they still order it, document the discussion and your knowledge of the contraindication, and consider going up your chain of command. It would be better not to refuse treatment but to collaborate on the best options. There is little published evidence on this. The one person who I am familiar with that has spoken on this subject in the past is Nadine Nakazawa (nnakazawa17@hotmail.com). 

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