Jakes AD, Twelves C, et al.
Breast cancer research and treatment. Date of publication 2015 Dec 1;volume 154(3):455-61.
1. Breast Cancer Res Treat. 2015 Dec;154(3):455-61. doi: 10.1007/s10549-015-3639-1.
Epub 2015 Nov 20.
Breast cancer-related lymphoedema and venepuncture: a review and evidence-based
recommendations.
Jakes AD(1), Twelves C(2)(3).
Author information:
(1)St James's Institute of Oncology, Leeds, UK. adam.jakes@hyms.ac.uk.
(2)St James's Institute of Oncology, Leeds, UK. C.J.Twelves@leeds.ac.uk.
(3)Leeds Institute of Cancer and Pathology, Leeds, UK. C.J.Twelves@leeds.ac.uk.
Lymphoedema is a recognised complication of axillary surgery in women with early
breast cancer. Such women are widely advised to avoid venepuncture on the
ipsilateral side lest this cause complications including lymphoedema. This can
lead to multiple failed venepuncture attempts causing distress to both patient
and healthcare professional. We reviewed current guidelines and critically
appraised the evidence relating the development of lymphoedema to venepuncture to
educate healthcare professionals and develop evidence-based guidelines. A
systematic search of bibliographic databases was performed and an Internet search
undertaken to identify patient information leaflets from societies and support
groups. Seven published articles were identified together with 15 published
patient information leaflets. Only one small prospective study was identified
(level of evidence 2), the remainder being case-control studies (level 3) or
retrospective reviews (level 4). There is no good evidence that venepuncture can
precipitate lymphoedema. New, patient-centred, evidence-based recommendations for
venepuncture in women with breast cancer are proposed. Whenever possible,
venepuncture should be performed on the contralateral arm. If this is not readily
achieved, in the absence of lymphoedema it is preferable to consider venepuncture
in the ipsilateral arm or insertion of a central venous device than to make
further attempts in the contralateral arm or resort to sites such as veins in the
foot. In the absence of lymphoedema, venesection in the ipsilateral arm carries
little, if any, risk of additional complications. We offer evidence-based,
patient-centred guidelines for venepuncture in patients with breast cancer
following an axillary intervention.
DOI: 10.1007/s10549-015-3639-1
PMID: 26589315 [Indexed for MEDLINE]
