What are negative effects of taking BP on lymphedema arm?

Mr. Joseph, hello,

I'm sorry to hear about this incident. In a life-threatening emergency whatever works to deliver life-saving care to a patient is admissible. Short of that it would be really wonderful if all medical personnel understood the importance of avoiding an area with lymphedema -- we're still working on it!

This women has a somewhat better chance of avoiding this situation in the future if she wears a medical alert bracelet on that arm. It should warn against needles, bp and IVs but should not use the word "lymphedema" because many medical providers don't understand or adhere to the restrictions associated with this condition but will honor a more general warning. Neon pink hospital alert bands are available free from Peninsula Medical, and many of us keep them in our purses and glove compartments to whip out in case of an emergency. They're somewhat more noticeable than a simple medical alert bracelet, but still no guarantee, especially in a truly life-threatening situation.You can order them here:
http://www.lymphedema.com/

I wonder about some of the wording in your post. For instance, I'm not sure what you mean by "recovering from lymphedema." It is a chronic condition, so we never really "recover," just get it under control and have to work to keep it that way. If she is now in more pain or experiencing new swelling this can again be brought under control, as Kira mentioned, with help from her therapist.

But do keep an eye out for any sign of infection: redness, rapid new swelling, increasing pain, itching, warmth to the touch, fever or general achiness. If she suspects infection she should get help immediately, as with lymphedema it can spread rapidly. Some women here have experienced cellulitis following injuries such as this without even a skin break, so it's important to be aware of the possibility

In case you're asking these questions with an eye to litigation, you should know that no one (to my knowledge) has successfully challenged lymphedema maltreatment. There are no agreed-upon standards for diagnosing lymphedema and as yet no universally-acknowledged best practices for handling it. As you can imagine, it is not possible ethically to do research regarding the safety of taking blood pressure on an arm with (or at risk for) lymphedema, so there is also no evidence-based data. All of which makes malpractice impossible to "prove" in court.

For what it's worth, I developed lymphedema in my left arm immediately following the use of a blood pressure cuff during a minor emergency, so I'm a believer in not using an at-risk arm for this. But who could prove one followed the other causally?

May I suggest that this woman consider meeting with Patient Relations at the facility she went to, and insisting that they better-train their ER personnel regarding lymphedema. She might enlist the help of her therapist in creating an in-service for ER staff to help assure that this doesn't happen to anyone else.

I'm really sorry for this set-back, and hope she soon has everything under good control!
Binney

MrJoseph, were the ER staff aware this person had even had breast surgery?  If a body is covered and you don't say anything, aren't wrapped or wearing a sleeve they'd not know unless told.  Binney, I remember one time you used the term (or something along these lines) 'medically compromised area'.  Seems they understand that term better than lymphedema which many medical people seem to think is not a big deal.  But that's all in hindsight now regarding your friend MrJ.  Perhaps it would be wise for this person to see a massage therapist as suggested in the posts above.  Don't leave it and hope it improves.  It's simply not worth the risk.  I hope things are feeling better soon.

Btw, Suzybelle, LOL at your avatar.  New hairdo?

I've been an RN for 28years & know to avoid needlesticks & BP in the arm on the mastectomy side. It's common knowledge & yes, there are other indications to not use limbs. It is common knowledge. In an "emergency" type situation, I(we) still avoid it. Since I recently had a BMX, for bialteral BC, with bilateral SNB-I'm not sure what I'm going to do. My BS thinks my LE risk is low. I was considering letting needlesticks & BPs to be taken on my non-dominant side(kinda sacrificing that side).

My real reason to respond to this thread is to say; I've seen some rather cute medi-alert type bracelets online. I think they might be overlooked & mistaken for "cute" bracelets. I don't work ED & usually "limb alert" patients are identified before they get to me. Just not sure the paramedics & ED personnel know to scrutinize jewelry this closely.

Excuse me, but the tone of the original post doesn't sit right with me. My gut reaction is this post is "written by a doctor with blame set on the patient after the fact." However, any real doctor wouldn't be coming to our LE forum with these questions. They would be in denial of responsibility for any potential harm and discussing with equally ill-informed peers. I smell a troll.



I apologize in advance if any real info is being sought (by a doctor to CYA) or if I have misjudged.



Suzy, I will have to change my avatar back to another I had briefly. We must have been separated at birth.

Yes, cryptic. I guess I didn't think a husband, family member or woman would refer to herself as "patient". It sounds impersonal and like a medical note. Sphygmomanometer? Okay, perhaps the poster has a medical background.

I will bow out of this discussion, as it is usually best to give folks the benefit of the doubt. This is a site where members come for support and deserve to be heard. My apologies. I hope the patient receives the care she needs.

Suzy, my pic isn't as much like yours as I remembered.  

I didn't get the tone of the first post: Mr. Joseph posted, and then has never checked back in to view any of this.

I find I always have to direct the nurses to my right arm, as most blood pressure cuffs are on the left for some reason.

My students are currently learning vitals signs, and are told to take the blood pressure on both arms, and I had to explain to them why they can't use me as a "patient"--I had one student let the pressure out so slowly (on my "good arm"), I thought I was going to scream....

In my office, a radiation oncology office, my nurse always asks--but when she's gone, the medical assistants have to be reminded. And we do have a number of bilateral patients.

Having just taught a first year class of medical students vital signs--I can tell you that LE risk and at risk extremity was NOT in the curriculum. Except for the few I could catch.

Kira

I am no le expert but when i had my first chemo, via iv on the left, my le arm is the right they put the bp cuff on my leg. the nusre said it would be a little lower but it would still work. Just my experience, :-) good luck!

Suzy, that pic looks like me after I get off the phone with Blue Cross. :-)



I think MrJ's post obfuscates his real intention in visiting this forum. :-p

I need a thesaurus or dictionary if I am going to continue to read this thread

I have had numerous blood pressures (all with the hand pumped thingie, not the automatic one), about 10 IVs and a million blood draws (that was a hyperbole) on my at risk arm and so far, I am okay.  Each and every time I am scared to death, but the people I have been dealing with refuse to use my foot or leg or anywhere else (I've tried and tried and gave up).  I usually refuse bp when I go to the doctor (get about one a month just in case).  

I am heading for an MRI tomorrow and I don't recall that they do the blood pressure but I do know that is another IV.  I'm hoping this one will use my foot, since it is at a hostpital. (I already have LE in one arm and am at risk in the other)...

OKay, I'm off to find a dictionary now.

I'm going to get flamed for this, but I'm going to say it anyway:

I am sad that we've reached a point where we find it necessary to make fun of someone who uses accurate (not "fancy", but accurate) medical terminology. The device is a sphygmomanometer... hard to pronounce, hard to spell, but, so what?

The O.P. came here and asked us a legitimate and important question.  His/her question is relevant to this forum.  I was going to add that he/she came here "in good faith," but some people seem to doubt that.  Can't we please let this go, now, and get back to more important issues, like what the symptoms would be if someone developed problems after a BP was taken on an at-risk arm?  Please?

otter

Otter, I aquiesce to your request. I had apologized for my initial comment and said I would bow out of the discussion, as I thought it better to give the poster the benefit of the doubt. My intentions were good, but it's clear I still doubt the sincerity of the poster.



I treasure the friendships I have made through this forum, and I certainly don't want to argue or cause any hard feelings. Please know the past two weeks have been difficult for me. I have been trying to determine how to obtain the services I have needed for many months and that my insurance continues to deny. I don't feel well, and I am frustrated and angry over my inability to get anywhere. The idea that someone might come here with a made up scenario is too much for me. I ask that you forgive me for being flip after promising to zip it.



With that being said, I do believe there are occasional trolls at BCO, and this is exactly the kind of post that is used to spark disagreements within a group. MrJoseph registered the day of his post and has not returned to acknowledge the comments posted by several members. I honestly found the style of his post more odd than his use of the word sphygmomanometer. As a former social worker who has worked in medical settings, in my opinion his post sounds like a medical note from a patient chart. Okay, as promised, I will now keep mum regarding MrJ's questions about this patient..

Alright, I'm going to wade in here:

This was an odd post, as it wasn't a dialogue, but rather an inquiry from a third party who didn't clarify his interest/relationship to the woman in question, and never responded to our posts.

I did not take any offense at either Suzy or Tina's posts: I actually found them humorous, and this thread is rarely humorous, so I appreciated them.

I teach a first year medical school course: introduction to clinical medicine (and we're working on correct taking of vital signs now) and one of the cardinal rules is to avoid jargon.

The average patient has a medical literacy of a fifth grader--obviously that varies widely, and the women on this board are clearly much more medically literate, but their response to to a medical jargon term is the response that most patients have--they feel like they're being confronted with medical language that they can't understand, and they get confused or feel left out of the conversation.

So, while I think the issue of taking a blood pressure on an arm with lymphedema is very important, I think the discussion that ensued was entirely appropriate and not disrespectful.

If a student used that term in a standardized patient interaction, I'd advise them to modify their language.

And on the topic of blood pressure: the last time I went back to my radiation oncologist's office, the nurse gave me a hard time when I declined to have my blood pressure taken on my arm with LE: they used a wrist cuff and she told me it wouldn't work as well on the right arm....I had to argue with her that no cuff, wrist or arm, was going on that arm.

And since this was the radiation oncologist who told me that NO study showed that irradiating the level 1 axillary nodes (when I questioned how far up my field went, as I already had LE before rads) caused LE, enough was enough. I never went back. And I'm still steamed at the lack of concern and the misinformation. 

Kira 

Maybe for the sake of forum sanity we should shut down this post and open another about general effect/affects (not good at grammar ) of BP or blood draws on a LE affected area and other locations to have blood or bp done.  I find the topic very interesting but the originator of this post causes too much controversy from the important part of the issue. 

 I really value all the advice given on this board, I troll off and on every day and the back and forth hurt feelings are sad.   So can we please put it all aside and start fresh?

Kathleen, that's part of the movement to debunk lymphedema risk precautions: there are no studies that have been done to either support or disprove them--it would be ethically difficult and there's no funding.

The lymphedema risk reductions are overwhelmingly based on clinical experience.

The movement to debunk them is very dangerous, IMO. The triggering incidence in LE can be minimal--as more evidence based studies show that there is a condition of stage zero lymphedema with no overt swelling, yet protein based lymph fluid is building up in the tissues.

If we can avoid triggering lymphedema, and do it fairly simply, why wouldn't we.

Ask Binney sometime how she feels with having a chronic disease triggered by a blood pressure measurement: even if the risk is low, if it happens to you, it's 100%

I heard a pro/con lecture about this at the NLN and Sheila Ridner PhD said: "When I sit in a support group, and hear women tell me how a plane flight triggered their LE, I take it seriously." On that line, check out Moogie's first posts.

There is a lousy study of dragon boat women who flew either short or long flights and the new onset of LE was low, if they didn't wear compression, and the conclusion was that compression wasn't needed on plane flights. Otter actually reviewed the short comings of that study. 

Here's the link to the Avon White paper about early diagnosis of LE

http://www.avonfoundation.org/press-room/expert-panel-issues-lymphedema-white-paper-calls-for-early-detection-and-intervention-to-reduce-lymphedema-progression.html 

The LE risk reductions are in the NLN position paper:

http://www.lymphnet.org/pdfDocs/nlnriskreduction.pdf 

III. Avoid Limb Constriction•

If possible, avoid having blood pressure taken on the at-risk extremity
• Wear loose fitting jewelry and clothing

Kira
 

Serenity, it sounds like maybe you saw Stanley Rockson, who is an eminent reseracher in Lymphedema, and has been very helpful to us as we seek information.

He's doing some great reserach on use of medication to treat lymphedema, and we await his publications.

Good for you to seek out this very important consult and thank you for sharing the information. It's really helpful.

Kira