A patient had clear fluid leaking from the PICC insertion. A new PICC was inserted. Leaking continued within 24 hours. Five layers of gauze is saturated within every 48 hours. No blood. No symptoms of infection or occlusive/thrombus complication. Interventional radiology and the Infectious Disease MD say basically "use the PICC and don't worry about it". When counseling the nurse for every 24 hour gauze dressing changes, the MD interpreted this to mean we "refused" to use the PICC and reacted negatively. In the absence of a defective or ruptured PICC would the likely reason be a fibrin sleeve with retrograde drug/saline leaking? Should we be infusing through this PICC?
Thank you.
Forum topic
Mon, 04/21/2014 - 11:58
#1
Leaking second new PICC
My first thought was it is the drug. Did IR do a dye study on the PICC? What drugs are being infused? Are there any signs of thrombis such as pain in the extremety, shoulder, neck, or chest? Edema, engorged veins in those areas mentioned in previous sentence? Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
Was second PICC placed in the same arm? The same vein? What is the primary and secondary diagnoses? Anything that contributes to hypercoagulablity? Where is the catheter tip located - CAJ or higher in the SVC? A fibrin sheath can form in 24 hours, so it is possible for this to be infusing fluid leaking out. If so, then it will not produce the therapeutic outcome needed. So I would think this should get the attention of infectious disease physician. I would want a dye study on the line. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi,
I would just like to share an experience I had. Please consider that the lymph system of this pt was disrupted during insertion of this line. That is assuming that the 2nd PICC was an over the wire replacement of the first leaking PICC. I had a pt, in my 14 years of PICC experience, with the same symptoms of clear, constant, profuse drainage from PICC insert site. We did all the testing to evaluate the line. CXRAYS, Flow studies, ultrasounds for clots, and the line tip was ideally placed. All the "normal" complications were ruled out and the line functioned normally except for the persistant drainage. We removed the PICC and inserted another on the other side, due to the risk of infection and his skin was getting irritated from the dressing changes. He did NOT have the problem on the new PICC inserted on the other side, and he was able to finish his treatment. The conclusion we came to as a team, with the physician, was that somehow the lymphatic system was compromised during insertion because there was no other evidence that it was anything else.
Good luck.
Jessica Carreiro, RN
Lahey Health System
This could happen especially if the PICC was placed on the left side. The thoracic duct, which is the primary connection of the lymphatic system to the venous system, connects to the left subclavian vein. To check for lymphatic drainage, do a glucose assessemet of the fluid, as lymphatic fluid is very high in glucose. I have seen a left sided implanted port have constant leakage of fluid from the port access site when it was accessed which turned out to be lymphatic drainage, aka chyle. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861