We have a patient who had a PICC placed two days ago. Today the insertion site began to drain a clear yellow fluid (looks like urine). He is receiving NO yellow colored fluids, no vitamins. The line was flushed strongly with NS and  no fluid appeared at the insertion site. Arm is not swollen at all, great blood return. First CXR at insertion showed tip at RA/SVC junction, today the PICC had migrated out 2 cm and a CXR shows tip in right atrium so line will be withdrawn an additional 4 cm. (so the reverse taper is pretty much outside the body)
What is this fluid? Could this be lymph fluid? What would the mechanism be? Did the catheter pass through a lymph duct and allow fluid to leak out around it? Any thoughts? Thanks! And best wishes for a nice Memorial Day weekend!
Lymph fluid is the first thing that comes to my mind. Test this by doing a glucose check of this fluid. If it is very high, it is lymph fluid. Is this PICC placed from the left side? The thoracic duct of the lymphatic system joins the subclavian vein on the left side near its junction with the internal jugular vein. There can be many variations of actually where these 2 systems merge. I just can not reconcile how the drainage would be clear yellow fluid at a PICC insertion site from this merger which would be so far away from the skin exit site. Please let us know what you determine to be the cause.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Yes, a lymphatic fluid can drain via picc site. which has light yellowish fluid, just like the one that drains from either from subclavian site left or right side.
MDACC will have a poster submission for this topic, hopefully on AVA or INS by my colleague.