Decreasing the risk of iatrogenic lymphoedema after axillary surgery: a threefold intervention

Procedures such as venepuncture and cannulation can precipitate Breast Cancer Related Lymphoedema (BCRL) in patients who have undergone axillary surgery. We noted that procedures were inadvertently being performed on the side of surgery at our hospital, as susceptible patients were not clearly identifiable to staff. An online anonymous staff survey at our hospital revealed that 26.9% of responders had seen procedures being performed on at risk arms in non-emergency settings. 83.3% of responders felt an intervention to allow easy identification of at risk arms would be useful. Our intervention was threefold. Firstly, we created an 'At Risk Arm' alert on the computerised records system. Secondly, we produced a warning sign for each susceptible patient's bed. The signs are displayed above beds, and returned to notes for use if the patient is re-admitted. Thirdly, we informed GPs via discharge summaries of the need to perform procedures on the opposite side to surgery. A second staff survey was conducted after implementation. 46.2%of responders felt that the new interventions would decrease the chance of patients developing BCRL. 61.5% felt that susceptible patients being more identifiable to staff would decrease the likelihood of procedures being performed on at risk arms. Our project showed the importance of ensuring axillary surgery patients are clearly identifiable to hospital staff during admission. Further interventions could include wristbands or patient alert cards. This work could be extended to include primary care and outpatient settings.