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Monday, April 21, 2014
Blood Pressure and Cancer
I would appreciate it if you could explain why you should not have your blood pressure taken in the arm of your masectomy side.
Your question is an important topic that I am pleased to address. The surgical procedures used for individual women who have breast cancer may be mastectomy, partial mastectomy, or lumpectomy.
Along with the actual breast surgery for cancer is the removal of regional lymph nodes and axillary (under the arm) lymph nodes to be tested for cancer cells. The nodes are examined by a pathologist to see if the cancer has invaded the lymph nodes. It is the way to see if the cancer has spread to other parts of the body.
I need to explain the normal function of lymph nodes. Normally, lymphatic fluid circulates through the lymph vessels, passes through the lymph nodes and enters the bloodstream near the heart. Lymph nodes filter or catch foreign matter and bacteria. If the nodes are removed as in breast cancer surgery, the normal drainage is impaired or causes a reduced capacity to carry the lymph fluid.
If there is pressure on the affected arm with taking a blood pressure, the fluid backs up and can cause swelling in the arm called lymphedema. Lymphedema is an accumulation of lymphatic fluid that causes swelling in the arm of the surgical side. This condition is painful and is a continuous risk for the development of infections.
Lymphedema can be a normal consequence or side effect of lymph node removal in breast cancer surgery. Therefore, anyone who has had either a mastectomy, lumpectomy, partial mastectomy, or modified radical mastectomy in combination with axillary node dissection should be educated about how to avoid lymphedema.
There are other precautions to take to avoid lymphedema besides having blood pressure checked only in the unaffected arm. Injections, IVs, or blood drawing should never be done in the affected arm. Avoid strenuous movements with the affected arm such as pulling, pushing or scrubbing. Avoid heavy lifting or carrying heavy objects such as suitcases, grocery bags and even heavy purses. Avoid tight jewelry or elastic bands around affected fingers or arm. Wear gloves for housework and gardening that might cause a minor injury. Avoid cutting cuticles of the affected hand.
It is recommended that patients wear a compression sleeve when travelling by air, especially for extended trips. It is very important that women who are at risk for lymphedema report any slight increase of swelling in the arm, hand, finger, neck or chest wall to her physician immediately. Also, an infection in the affected arm could be the beginning of lymphedema. Again, see your physician for a rash, blistering, redness or heat in the arm or hand.
Thank you for writing.
Janet Trigg, RN, MSN, EdD
College of Nursing
University of Cincinnati