This article is taken from the Winter 2009 issue of LymphLine, the LSN's quarterly newsletter available to all LSN members.
For details of how to become a member, click here.
Common sense rules at the Royal Colleges of Anaesthetists and Surgeons
By Karen Friett, LSN Chief Executive
Last year, Anita and I attended an event of the Post Graduate Medical Education and Training Board which was being held to discuss the training needs of future doctors. Over lunch I met Anne Murray who is Lay Chairman of the Patient Liaison Group (PLG) of the Royal College of Anaesthetists (RCoA). We had a conversation about the challenges faced by breast cancer patients who are at risk of developing lymphoedema when it came to requesting the 'at risk' arm not be used by anaesthetists for drips and blood pressure readings. The conversation was very positive and I left my card with Anne should she ever have need to discuss it further. I was delighted to receive a letter in January from Anne explaining that the Patient Liaison Groups of both the Royal College of Anaesthetists and the Royal College of Surgeons had launched a joint initiative to look into the issue as it had been raised as a concern.
The key issues were the inconsistency of information and support given both to patients and clinicians and the concerns of patients who had had breast surgery but were in hospital for an unrelated issue, who felt that their informed concerns were being dismissed by some clinicians. The whole subject was looked at in some depth within the RCoA in collaboration with a Professor of Breast Surgery and the draft findings were then sent out to key professional and lay groups for comments. We were very pleased to comment and to pass the paper onto Professor Peter Mortimer who also added his thoughts.
The final documents, one for patients and one for clinicians, have now been reviewed and approved by both the Royal Colleges and have been published on the Royal College of Anaesthetists web site www.rcoa.ac.uk. The document acknowledges that there is often a lack of, or conflicting, evidence that using the affected or at risk limb increases risk or affects lymphoedema, and that avoiding doing so, except in life or death situations, is common sense.
In real terms, this means that surgeons and anaesthetists are being advised to accept that anyone who has had surgery involving the lymph nodes under the arm should be considered 'at risk' of lymphoedema and that that limb should not be used to site drips, take blood samples or any other procedure unless there are overriding clinical reasons (such as immediate risk to life).
Further, if the limb has to be used, then the reason for it should be recorded at the time in the anaesthetics records or patient records. This is important as it should make the health care professional stop and think about why they are using the affected limb. Another suggestion made in the information for doctors is that the use of identification bracelets to identify which limb is 'at risk' from, or has, lymphoedema is a useful precaution. Such identification bracelets can be obtained from the LSN. Please remember that health care professionals are not mind readers - you need to raise your concerns with your anaesthetist and surgeon. You may find it useful to download the information and take it to hospital with you.
The document closes with the summary 'we all need to work together to ensure that we take as many sensible precautions to prevent lymphoedema getting worse. There are no absolute rules on avoiding procedures, but it is obvious that avoiding such risks where possible is best practice.'
The LSN is delighted that the Royal Colleges have listened to the concerns of patients and have taken such a positive step in addressing them!
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