IV Therapy

**kariann11** · 06-06-2009, 08:59 AM

Your patient had a right mastectomy (1998) and a left lumpectomy (2001). Where would you insert her intravenous line/

**reesern1963** · 06-06-2009, 10:27 AM

Did either side require node dissection?

**peady2** · 06-06-2009, 11:56 AM

Are you using us to do your homework? I answered your question on PE but a simple google search-or your textbook-would have provided the same answer.

Reese's point is that more information would better assist you in determining the appropriate answer if this were a clinical real life situation. But if this is a test and all you have is the question as written-think of this: Which side was subjected to the least trauma?

If this is real life-ask the doc where s/he wants the IV inserted.

**kariann11** · 06-06-2009, 03:08 PM

the question didn't give that info. I was leaning toward the lumpectomy, because with a mastecomy, it was my understanding that , that was always a no...no.

**kariann11** · 06-06-2009, 05:44 PM

Obviousley, I was unable to find the answer through google that I was comfortable with. To answer your question, no, I am not using you to do my homework ... since school has been long behind me. It was a question I came across on a competency and since it is not my area of practice, I was unsure, but thank you for you help anyway.

It is that know-it-all attitude that keeps nurses from learning from one another. I guess your kind is not only found in the work place, but on line too

**peady2** · 06-06-2009, 07:26 PM

Originally Posted by kariann11

the question didn't give that info. I was leaning toward the lumpectomy, because with a mastecomy, it was my understanding that , that was always a no...no.

Is it also your understanding as to why it is "always a no...no" (not "always" btw) to insert an IV on the affected side? If not, I will explain-a mastectomy usually involves multiple node dissection, a lumpectomy may not, although in recent practice lumpectomy with sentinel node dissection is usually done. Therefore, there is a greater chance of lymphedema on the mastectomy side, which is likely to have had multiple node dissection, vs the lumpectomy side, which is more likely to have had single node dissection, should the IV cause trauma at the site, resulting in the inability of the limb to drain lymphatic fluid from the area.

I am surprised that your textbooks would not have made this clear.

BTW-My "kind" simply asked you a question as to whether or not this was homework, because this "know-it-all" is quite surprised that an experienced nurse who states "school has been long behind me" would not have either the knowledge to answer the competency questions or the where-with-all to find the answers.

**peady2** · 06-06-2009, 07:29 PM

Obviously.....

**NurseEducator** · 06-09-2009, 08:07 PM

Karian, I agree with Peady on her answer to question. I imaging he/she did not mean it the way it sounded. Don't know the person just saying often, on email, text, and this kind of setting, you can't see the person or facial expressions or hear the tone and misunderstandings happen. Sometimes things come across different than they way we mean.

**kimaesha** · 06-23-2009, 03:31 AM

hi im a newbie here ^_6

**esyemerueh** · 07-22-2009, 01:02 AM

Hello! I am a new grad looking for a job in the Los Angeles area. What can I do to find a job?

**RyanRN** · 07-22-2009, 06:38 PM

I'm choosing the lumpectomy side (rationale per Peady) BUT - ask the doc, get an order.

**Edson!** · 07-22-2009, 11:23 PM

I have to agree with Peady on this one.

Bottom line would depend on why and how urgently pt needed the line and where it could be gotten. But that is real life. It's like when people say don't take BP on this arm b/c of mastectomy, etc. Reality and urgency will dicate not to worry so much with that. In every day or routine practice, however, it should be observed. But when someone is crashing, they're crashing. . .so with things like this, the rules can change--at least temporarily. If I have a good line in one arm and am frequently giving emergency meds through it, yes, we will take the BP on the arm if the patient doesn't have an art line. Peripheral pressures can be taken as well, but with certain situations or even as person gets old, the pressures at four points can differ. So, a more accurate BP will probably be in the upper extremity. See the clinical responses can change depending on the specifics--whether it be taking a BP or inserting an IV in a patient with a hx of mastectomy, etc.

However that doesn't answer the test question, but I believe peady's explanation does.