lymphoedema - new guidance for doctors and patients

Has anyone seen this information on the website of the Royal College of Anaesthetists? - about using the affected or at risk arm for medical procedures.
It also contains a link to information you can print off for your doctor which could be very useful.

Hi Seeker

I have posted to you on bcpals, so will only refer to this guidance in my reply…

…I disagree strongly on their advice regarding BP. If no arm is available, I believe they should use the thigh or ankle.

BP taken on my least bad lymphoedema arm was very painful and made it worse. I feel I can’t be the only one that this would happen to.

Good though, that the rcoa has at least addressed the issue.

X to all


Hello S
I agree with you that it would be painful. I was worried about your reply so looked again at the advice and it does recommend using another limb if lymphoedema is present.

It does say that at the moment there is no actual evidence that using a blood pressure cuff on an affected arm causes harm - but urges doctors to err on the side of caution, listen to patients’ concerns, and to use another limb.

I hope this reassures you a little.

Hi Seeker

I am heartened by the issuance of the rcoa guidelines, but it will be a long time before I am totally reassured that doctors will abide by them.

I woke up from a hysterctomy a few years ago with an automatic BP monitor chuntering away on an arm. I’d asked for my arms to be left alone and ensured it was written across the top of the notes that accompanied me to theatre. When I asked why no-one had acceded to my written request, I was told that they’d ‘missed’ that bit!

I think there are a lot of communication problems. You may tell one nurse, one doctor, but they don’t pass it on, don’t write it down. It pays to be forever vigilant, I feel.

I am also afraid that the statement ‘there is no actual evidence that using a blood pressure cuff on an affected casuses harm’ will be enough to convince doctors, nurses et al that they needn’t bother using a leg, which takes more time and involves applying a correction to the reading; see below (not mentioned, as far as I can see, in the rcoa guidelines).

Furthermore, whilst I might consent, in extremis, to a single BP reading on my least bad arm (for a one-off comparison with reading at an ankle), I would not want this to be taken as a carte blanche to perform repeated readings on it. I don’t think the rcoa advice mentions anything about frequency of readings (I may be wrong) - I would be particularly concerned about the use of automatic BP monitors, as they seem to exert more pressure and there is a tendence to fit one to a patient and then wander off and leave them.

I believe to get the most accurate reading from a leg you need to be laying down for about 5 mins beforehand.

However, when I got lymphoedema in both arms a few years ago, my then GP wrote to a local cardiovascular consultant asking for his advice on taking BP on legs. I asked her for a copy of his reply as I thought it was very useful to carry with me for hospital visits/stays.

Here’s what 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 [for non-automatic devices]. Generally blood pressures measured distally are around 10 mmHg systolic higher than centrally measured BP. This is because the pressure wave form changes on passing into smaller arteries, in much the same way as waves become higher and steeper when they pass into shallow water’.

So a BP reading on a thigh or calf (or better still, ankle - calves and thighs can be painful) will always be higher than when taken on an arm.

So if a leg is going to be used for BP, you need to have been lying down for at least 5 mins and a correction applied to the systolic reading.

I have a soft copy of the vascular consultant’s letter and am more than happy to send a copy to anyone who pms me with their e-mail address.



This should be straightforward shouldn’t it? When I had my surgery I had an axillary clearance on left side. My right arm also couldn’t be used for BP as I’d had thromboses in the vein there.

I had my BP taken around by calf for the most part. This was quite painful particularly with the automatic machine. When one nurse struggled with it I refused to let her carry on and told her she could put that in my notes to cover herself if needs be. I also had it taken on my ankle and that was fine. I was in hospital for 6 days and it was done like throughout.

When I had some further surgery as my wound broke down and then later when I had a portacath inserted, the anaesthetists were great about it all. Both did the anaesthetic through a vein in my foot. shows it can all be done.

I agree that we have to be hypervigilant about what they do and keep reminding them. Communication is really poor. Always ask for a warning note to be put on the top of your observation chart as well as in the notes. Nurses rarely read the notes at the start of a shift.

Elinda x