Ipsilateral placement of IV Catheter in patients undergoing Breast Cancer Surgery found safe

In a new study conducted by Julian DO Naranjo and team it was found that there were relatively few difficulties in patients who had an intravenous line (IV) put for surgery after a prior breast cancer surgery, and none in patients who had an IV placed ipsilateral with axillary node dissection. The findings of this study were published in Anesthesia & Analgesia, in the month of September, 2021.

There is a persistent belief that IV insertion in the arm ipsilateral prior to breast cancer surgery is prohibited in order to avoid breast cancer–related lymphedema (BCRL). The purpose of this retrospective research was to assess the risk of BCRL development in ipsilateral arm IV placement vs contralateral arm IV placement in previous breast cancer surgery.

This study was a retrospective analysis of IV placement for anesthesia and surgery in patients with a prior history of breast cancer surgery with or without axillary lymph node dissection using Integrated Clinical Systems and Epic Electronic Health Record. Complication rates for IVs put in the ipsilateral and contralateral arms were compared. A total of 3724 patients with a past history of breast cancer surgery who were receiving 7896 IV placements between January 1, 2015, and May 5, 2018, were identified via their index anesthetic and surgical procedures.

The key findings of this study were as follow:

1. The average interval between breast cancer surgery and IV implantation was 1.5 years (range, 1 day to 17.8 years).

2. A problem occurred in 2 of 2743 IVs inserted in the arm contralateral to prior breast cancer surgery, resulting in an incidence of 7.3 per 10,000.

3. A problem occurred in 2 of 5153 IVs inserted in the arm ipsilateral prior to breast cancer surgery, at an incidence of 3.9 per 10,000.

4. The incidence of complications did not change substantially across groups (P =.91), and the 95% confidence interval for the risk difference (ipsilateral versus contralateral) was 23 to +8 problems per 10,000.

5. When only the first IV put during breast cancer surgery is evaluated, the complication rate is comparable.

In conclusion, this study suggests that it is not required to avoid IV insertion in the arm ipsilateral to breast cancer surgery.

Reference:

Naranjo, J., Portner, E. R., Jakub, J. W., Cheville, A. L., & Nuttall, G. A. (2021). Ipsilateral Intravenous Catheter Placement in Breast Cancer Surgery Patients. In Anesthesia & Analgesia (Vol. 133, Issue 3, pp. 707–712). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1213/ane.0000000000005597

Keywords: Breast Cancer, axillary node, catheter, lymphedema, recurrence, intravenous line, implant, oncology, anesthesia, analgesia,