Using the Ipsilateral Arm in Patients With Breast Cancer: An Evidence-Based Practice Project and Practice Change

BACKGROUND: The ipsilateral arm is not used for blood pressure, phlebotomy, or IV access postmastectomy or post–lymph node removal or biopsy. The non–evidence-based practice of blanket forbidding of ipsilateral arm use can result in inaccurate calf blood pressure measurements, foot stick blood draw orders, and an increased need for tunneled central venous catheters. OBJECTIVES: This project piloted a practice change and allowed for the use of the ipsilateral arm in patients with breast cancer. METHODS: The team used the Johns Hopkins Evidence-Based Practice Model to implement a practice change for hematology-oncology inpatients with breast cancer and lymph node involvement, removal, or biopsy, or mastectomy history. FINDINGS: Twelve months after implementation, more than 100 patients with breast cancer participated with zero incidences of resulting lymphedema. There were no foot stick orders or calf blood pressures in patients when the ipsilateral arm was used. After 16 months, the practice change became a systemwide policy.