Both Arms at Risk

There are loads of recommendations for all injections and blood tests to be given in the unaffected arm. What if both arms are at risk?

Hi Gardenia

I have lymphoedema in both arms and I do not permit blood to be taken, injections given or blood pressure taken on either arm or hand.

I tell medical staff they cannot touch my arms. They very often assure me there’s no risk. There is - in my case of making the lymphoedema worse, for someone who does not have it, of triggering lymphoedema for which there is no cure and only rather primitive treatments.

What normally happens is that they use a vein in my foot, which sometimes has to be warmed in a bucket of warm water before the procedure is successful. I also advise them to use a smaller cannula, as this makes it easier in small foot veins, altho’ many insist on trying a standard size first. I’m afraid I don’t tend to win any popularity contests with this approach, but I feel it’s vital to stand my ground on this issue.

The lymphatic system is poorly understood and little researched. If you have lymphoedema, or are at risk of developing it, the chances are you will already know more about it (in terms of risk management and contra-indications) than many health professionals, including GPs (who often prescribe diuretics which simply make things worse) and oncologists.

As for blood pressure, it can be taken on the thigh or calf. They may have to search around or buy a bigger cuff for this, but that’s their problem. The stress that BP measurements put on ‘at risk’ arms is immense and should be avoided unless the situation is really and truly life or death. NB: the BP reading from a leg tends to be about 10mm Hg higher than that taken on an arm.

General anaesthetic: It is possible to use an old fashioned mask to put a patient under and then insert a line or lines in their neck (instead of their hands) - this is what happened to me last time I had a GA. It worked a treat!

Bye 4 now


Hi S,

many thanks for your reply. You sure know what you’re talking about!!!

I’m on chemo now and they insist in using the arms and I’m not happy at all.

Will try to be more upfront next time.

All the best,

Hi Gardenia

I am sure, from reading the posts of others on this site, that you should have been offered a line - Picc, Hickman, Grouschon or, best of all, a Portacath, to overcome this problem for chemo. I am sure someone will chip in with more recent experience than mine about these.

I think you definitely need to ask - these methods seem to be quicker and easier and avoid the veins that are not ‘up’ to it.



Me again - just dug out a copy of letter from a consultant cardiologist to my former GP (she wrote to him when it became apparent to her that I wasn’t ever going to let her take my BP on either arm again).

He wrote:

‘it should be possible to monitor her blood pressure measured at the ankle. This can be checked by putting a cuff around her thigh and listening in the popliteal fossa. Generally blood pressures measured distally are around 10mmHg systolic higher than centrally measured BP. THis is because the pressure wave form changes on passing into the smaller arteries, in much the same way as waves become higher and steeper when they passinto shallower water’.

Has to done lying down!



Hi Gardenia

Like Bahons2 (who has covered most points very well), I also have lympoedema in both arms and on occasions have to do battle with some non educated medical professionals to ensure that they don’t use either arm for ANYTHING (i.e. bloods, cannulation or blood pressure).

I have had a few admittances to hospital and ops since getting lymphoedema in both arms and I make absolutely sure that the anaesthetist uses my foot or a central line in the neck. Last year I had to have 6 weeks of IV anitbitotics (due to MRSA knee infection after broken leg treatment) and my foot veins began to pack up so I had a hickman line put in. I have taught many a nurse and even a couple of medical students on taking blood pressure from my leg,

Unfortunately many phlebotomists and some other medical staff will try and insist there is no problem and argue the point. I told my ward nurse I was being hassled in this way and she wrote a big sign over by bed saying ‘NO bloods or BP to be done on either arm’.

The only exception I had to make was for a CTPA scan for which I had to be cannulated in the hand in order to administer the dye (apparently the feet are too far anyway from the lungs for the test), I was very reluctant to do this but as it turned out it was a good thing I did as it showed up multiple pulmonary emoboli. I had the doctor take the cannula out immediately after the test and despite and a couple of days of worrying swelling, it returned back to normal.

If I had to have any more regular IVs I would demand that I had a hickman or other line type put in for administering as my foot veins are little fragile now.

Be assertive and don’t let them bully you
Good luck