The controversy of arm-based injection has been addressed a long time ago and the guideline is to avoid using the arm at risk of lymphoedema for instance. I have first been made aware that this guideline has been blurred at the last Lymphoedema Support Group meeting I have attended. The following question has been raised, “Is it true that we can now safely have an injection or blood pressure taken on the arm at risk of developing lymphoedema?” The issue has also been discussed at the more recent Lymphoedema Information Day.
I have investigated this claim and have found an article, which has been published in 2016 by the Journal of Clinical Oncology that states there is no sufficient evidence to recommend protecting the limb at risk of developing lymphoedema and avoid injection or blood pressure measurement. I find this article careless because it is true that there is a paucity of information. This is no good reason to throw caution to the wind. Lymphoedema is chronic and there is no cure.
Judith Nudelman states, “It is a narrow finding and not a definitive conclusion”. She has a special interest in cancer survivorship and lymphoedema. She writes that lymphoedema requires clinical evaluation to be diagnosed because there is not yet a universal objective to do so. This means that the diagnosis is based on guidelines, experience, measurements, observation, palpation and a good clinical judgement.
On the other hand, we hear much anecdotal evidence on causes of lymphoedema. Some statements include:
· “I was bitten by a mosquito and not long after, I developed lymphoedema”.
· “My cat scratched me”.
· “I was sunburned”.
· “I relocated, was busy and I lifted heavy furniture”.
· “I was carrying a heavy bag and I think that did it!”
· “I don’t know what happened”.
Practitioners have an ethical medical principal that cautions them from doing anything carrying the potential to hurt a patient. This is called ‘Do No Harm’. Nudelman cites this principle as a guide for treating lymphoedema.
On the other hand, we know that the skin forms an active barrier to organisms and microbes that carry diseases. That being said, a needle prick leaves the skin vulnerable to air borne bacteria, infection/cellulitis and subsequently lymphoedema. Why take the risk? The health care system is in crisis because we systematically neglect wellness and prevention.
We can adapt to the notion of what does not kill us makes us stronger, or we can practice caution to protect the limb at risk of developing lymphoedema.
Intellectuals solve problems, geniuses prevent them!
References
Brunelle, C., Swaroop, M., Asdourian, M., Sayegh, H., & Taghian, A. G. (2017, September 1). Precautionary Behaviors and Breast Cancer-Related Lymphedema. Retrieved November 14, 2023, from Mary Ann Liebert, Inc. Publishers: https://www.liebertpub.com/doi/abs/10.1089/lrb.2017.0016?journalCode=lrb
Nudelman, J. (2016, September 1). Do No Harm: Lymphedema Risk Reduction Behaviors. doi:DOI: 10.1200/JCO.2016.67.9928 Journal of Clinical Oncology 34, no. 25 (September 01, 2016) 3109-3110.
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