After lymph node removal as part of breast cancer treatment, many doctors recommend avoiding blood draws on the side where you had surgery. However, more recent research suggests that blood draws on that side may not be as likely to cause problems as health experts previously thought.

Guidance on blood draws after lymph node removal varies by medical center and depends on the type of surgery you had. If you’ve had lymph nodes removed or had radiation therapy to the armpit, you may need to take extra care with blood draws. This is also important if you may have one of these procedures in the future.

When Might You Need Blood Draws?

Healthcare providers order blood draws when they need a small sample of blood for testing. Blood draws are also called blood extractions, venipunctures, or phlebotomies. This usually involves placing a thin needle into a vein in your arm.

🗳️ When you’re having blood drawn, do you ask the person drawing your blood to:

Use the arm on the side where you didn’t have treatment

Draw blood from either arm

Draw blood from a foot or another body part

Only draw your blood if they have experience with breast cancer survivors

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Your doctor may need to collect a blood sample during the course of breast cancer treatment for various reasons, including:

• Performing a complete blood count, a test that measures different types of blood cells and can help show whether cancer treatment is causing problems such as anemia (low levels of red blood cells)
• Measuring substances that show how well your liver or kidneys are working to make sure that you’re healthy enough to receive treatments like chemotherapy
• Assessing levels of proteins called tumor markers that your cancer cells may produce, which can show whether treatments are working

Blood draws are also often part of a regular checkup. Blood tests can help your healthcare team better understand your overall health.

Risks of Blood Draws

Blood draws can lead to side effects for anyone, whether or not they have cancer. These side effects include mild bleeding, bruising, and pain.

It’s also possible, but extremely unlikely, to develop an infection from having your blood drawn. The risk may be slightly higher for people who are immunocompromised, meaning their immune system is weakened.

However, healthcare professionals take precautions to protect themselves and the people they care for. These include:

• Washing their hands frequently
• Wearing gloves and other types of personal protective equipment
• Using needles only once
• Disinfecting surfaces
• Cleaning the area where blood will be drawn with an appropriate disinfectant

Are Blood Draws Safe After Lymph Node Removal?

Lymph nodes help drain fluid out of your tissues. People who have had surgery to remove their underarm lymph nodes may have a higher risk of developing lymphedema. This is a fluid buildup in the affected arm that may lead to pain or swelling.

Depending on how severe the lymphedema is, there may also be numbness or tingling. The skin may look or feel different, and clothes or jewelry may feel tighter on the affected arm.

“I only have blood drawn at an oncology office or lab. Some medical assistants in a doctor’s office just aren’t comfortable doing it.”

— A MyBCTeam member

Some doctors still caution against getting blood drawn from an arm on the side where lymph nodes were removed. This warning was based on one small study from nearly 20 years ago. In that study, people were more likely to develop lymphedema when blood was drawn from the arm on the side where lymph nodes had been removed.

However, a larger, more recent review found mixed results. Some studies linked blood draws with a higher risk of lymphedema, while others found very little or no risk.

Cellulitis, a common bacterial skin infection, may raise your risk of developing lymphedema. As noted, infections from blood draws are very rare, but they may trigger lymphedema if they occur.

There are several ways to lower the risk of lymphedema and ease its symptoms. These include:

• Avoiding heavy lifting or repetitive movements with the affected arm
• Wearing loose-fitting clothing and avoiding tight jewelry or anything that puts pressure on the affected arm
• Trying massage or physical therapy

Blood Draw Recommendations

Some healthcare providers recommend getting blood drawn from the arm on the side that wasn’t treated for breast cancer, although others say either arm may be OK.

In some cases, it may not be possible to draw blood from the opposite arm. In that situation, many healthcare providers say it’s safe to use the arm on the side where you had treatment.

Your risk of developing lymphedema is often highest soon after surgery, but lymphedema can develop months or years later.

Where Do You Draw Blood After a Double Mastectomy?

For people who’ve had lymph nodes removed on both sides of the body, health experts often recommend that they have blood drawn from either arm or talk to their doctor about which options are best.

In some cases, doctors may recommend drawing blood from other veins, such as those in the foot. However, using the legs or feet is generally considered a last resort because the complication risk tends to be higher.

Members of MyBCTeam who’ve had lymph nodes removed on both sides or have undergone a double mastectomy have discussed trying to get blood drawn from other locations.

“No one seems to know how to draw blood from another area,” said one member, noting that their provider recommended calling ahead to make sure they received necessary accommodations. “I need someone with experience.”

Tips for Managing Blood Draws

If you need blood drawn from your affected arm, consider asking for a phlebotomist who has experience with lymphedema prevention. A phlebotomist is a healthcare professional trained to draw blood. You may have to go to a specific location to receive this type of care.

“I only have blood drawn at an oncology office or lab,” one member wrote. “Some medical assistants in a doctor’s office just aren’t comfortable doing it.”

If you want to avoid getting blood draws on your affected side, or if your doctor recommends doing so, you might want to get a medical alert bracelet. In case of emergency, this will tell providers not to draw blood from or start intravenous (IV) lines in that arm. You may also want to ask your doctor to put this information in your chart.

One member, who had lymph nodes removed on both sides, wrote, “I’ll have a bracelet for the arm that had most of the nodes taken out, so they only touch one arm — the one that had the fewest nodes taken out — in case of an emergency.”

“I’ll have a bracelet for the arm that had most of the nodes taken out, so they only touch one arm — the one that had the fewest nodes taken out — in case of an emergency.”

— A MyBCTeam member

You can also protect against lymphedema by avoiding injections, IV lines, or blood pressure readings in the affected arm. Also, watch for signs of infection after blood draws or other medical procedures. Tell your doctor right away if you notice discoloration, warmth, or swelling in an area of your skin.

Join the Conversation

On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

Do you avoid blood draws on the side where you had breast cancer treatment? Let others know in the comments below.