A Review of the Literature Related to Limb Precautions After Lymph Node Dissection

Background: Upper extremity limb precautions are recommended for patients who undergo axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) to lower the risk of lymphedema. Limb precautions involve avoiding use of the affected arm for point-of-care testing, venipuncture, and blood pressure measurement, all of which can affect quality of life and create delays in care.

Objectives: This review provides a summary of the evidence regarding limb precautions and evidence-based interventions to lower the risk of lymphedema after ALND or SLNB.

Methods: A literature search was conducted using CINAHL^®; PubMed^®; Education Resources Information Center; History of Science, Technology, and Medicine; Cochrane Library; and Joanna Briggs Institute databases.

Findings: Evidence supports exercising the affected limb, maintaining a body mass index of less than 25, and massaging to lower the risk of lymphedema. There is limited evidence for avoiding IV catheter placement and venipuncture in the affected arm following ALND and SLNB. Best practice is to assess the patient for risk factors of lymphedema before recommending selected evidence-based limb precautions.