In the context of mastectomy with axillary lymph node dissection, which insertion site is NOT recommended?

In the context of a mastectomy with axillary lymph node dissection, the ipsilateral insertion site is not recommended due to the increased risk of complications such as infection or thrombosis. When lymph nodes are removed, the regional anatomy changes, and there may be altered lymphatic drainage, which can make any vascular access procedure more challenging on the same side. Inserting a catheter on the side where lymph nodes have been excised can lead to complications because of potential lymphedema and scarring from the surgery.

In contrast, the other options, while they might have their own indications or limitations based on patient-specific factors, do not share the same heightened risk associated with cannulating on the side that underwent dissection. The external jugular vein and femoral vein provide alternative sites that are typically free from complications linked to the surgical site. Moreover, the subclavian vein can still be accessed safely, although care must be taken due to its proximity to the surgical area. Therefore, avoiding insertion on the ipsilateral side maintains patient safety and mitigates the risk of complications post-dissection.