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Exudate/"weeping" one month post PICC insertion. Opinion?

Does this look ok to you?

My homehealth nurse (who came yesterday to draw labs/change dressing) if I recall correctly, said that the area around my PICC was "weeping" (presumably from a reaction to the dressing itself?). She cleaned the area and applied a new dressing. This morning I woke up with yet more of this nasty "goo" under the dressing. I hate to ask her to come back out here again unless it is really necessary.

If you were me, would you call?




p.s. Hopefully only a few more weeks of IV antibiotics for me, and then I'll be out of your hair for good :)

Michele's PICC on 5-5-07

This "weeping" has now

This "weeping" has now "wept" out of the dressing/tape and onto the coverup thing I use when I go out in public.


Lovely. Just lovely. 

I called Home Solutions (the

I called Home Solutions (the home health agency who is providing my PICC care). The on-call nurse mentioned that she wasn't at home at the moment (I had offered to email her the picture if it would help her decide if a visit was warranted), I was kindof far away, and that it was getting a little late (it's a bit before 7pm right now).


She suggested I put a little gauze under the catheter, near the spot where it was oozing out from under the dressing, so it would essentially sop up the exudate (I think that's the right word), and then to put some tape over the top of that to secure it. She said then to see if it was still oozing in the morning. We actually already had gone out to CVS to get some tape so we could change it out (it was nasty).

I guess I am concerned a little bit about infection. If this "exudate" oozes into the PICC opening, is that problematic at all? If it stops oozing, should I go ahead and wait until next Friday when my home health nurse is scheduled to return?

Here is a picture from tonight (7pm).

 red line near picc site


micheles picc 5-7-07 at 7pm

Brief update: Incredible

Brief update:

Incredible nurse just left my home. She was competent, kind, helpful, and very honest (something I appreciate).

She removed the PICC. It was infected (gooey oozy crap all along the line).

Susan S
Thank goodness you had it

Thank goodness you had it removed!

It looks to me as though you have a sensitivity to adhesives too.  Very red marks in the area of the steristripes and that clear tape.   In the future request paper tape or tape for sensitive skin.


Good luck with the rest of your therapy!

Susan Schuetrumpf, RN, CRNI, VA-BC
Atlanta GA

Angela Lee
I think it is great that you
I think it is great that you can take a picture and send it to your nurse if necessary--I have never thought of having home patients do that.  I wanted to ask if you would consent to allowing your picture(s) to be copied and used for teaching purposes---you would not be identified by name and since it's a close-up of your arm obviously that would not identify you.  Thank you.
Certainly, Angela. You can

Certainly, Angela. You can consider this my official consent to use my pictures for training purposes. Hopefully it will be helpful to someone someday.

Thank you, Susan, for the heads up in re: paper tape. I will be sure to request that in the future. I had been having rash/itching with the dressing for a few weeks.

I have to admit, I am a little concerned about whether or not an infection could have reached my bloodstream (since the line was riddled with similar appearing "goo" as was on the outside of my arm). Hopefully, this will all clear up just fine, and I'll chalk it up to "lesson learned". Who knows? Maybe I am allergic to the line material itself .

A friend of mine who is also being treated for Lyme mentioned that it looked like a yeast/candida thing to her (the kind nurse from yesterday mentioned this , as well, I think). Hopefully none of that nasty fungus has made its way into my bloodstream! I understand that could potenially be quite a serious situation.

In the meantime, I'll keep monitoring my temp and keep an eye out for any other unusual symptoms. My infectious disease doc hasn't called me back, and my lyme doc basically just told me to contact the ID guy. Maybe we'll hear from him soon.

Thanks again, everyone,



p.s. I have a picture of it from this morning, as well, if it would help (PICC line gone, red, bubbly ick remains)

Timothy Royer B...
Michele  These are


These are wonderful teaching pictures.  I am also asking if it is ok to use these for teaching purposes and not publication and just list the originator as NewPatient? 

You can e-mail me back privately at [email protected].  I would also like the picture you took this am with the PICC removed.

Another question.  We often would like to read or hear about the experience of having a PICC placed, the therapy, the good parts, and the problems from the patient's perspective.  May I suggest you write for the one of the Infusion Journals?  Things like this benefit us and the patient.  E-mail me privately and I will help get this published.  Or how about coming to speak at conferences from the patient's point of view.  It would be quite welcome.


Susan S
Michele you have

Michele you have me curious to see your arm without the PICC.  Will you post the pic please?

I also agree with Tim about an article from patient's perspective.  But maybe even have it published in a more widely read Journal than AVA or INS.  

Susan Schuetrumpf, RN, CRNI, VA-BC
Atlanta GA

As requested, I've appended

As requested, I've appended a couple of pictures of my arm which were taken following removal of the PICC line. I had received a request to refrain from posting additional pictures, but am going to assume it is acceptable when directly requested by users.

I would be more than happy to write or co-author an article addressing PICC line experience(s) from the patient perspective. I'm a doctoral student (only dissertation left to go!) in Counseling Psychology, and have done a fair amount of writing both recently and in the past. If any professionals would like to pursue the article-writing/presentation idea, I would be happy to oblige.

I think it would be beneficial for home care patients who are internet-connected, to be presented with the opportunity for "blogging" their experience online. Not only could this represent an oustanding opportunity for interested healthcare professionals to vicariously experiencie a given procedure from the patient perspective (it wouldn't have to be limited to PICCs), but it could also serve as adjunctive "real time" remote monitoring.

If patients who happen to have webcams and internet access were willing to participate, his/her nurse could have 24-hr access not only to live action pictures of the patient, but also to self-reported vital stats if necessary (e.g., temperature, blood pressure if they had a blood pressure measuring device, ratings of pain, other symptoms).

Perhaps medical "blogging" by patients could prevent unneccesary trips by home health care personnel (thus saving time and money). Inaddition, this adjunctive service could be very valuable for patients for whom language barrier is an issue (pictures don't lie). Perhaps more importantly, a "real time" adjuctive "blogging" service could ALERT home health care nurses/personnel to potentially life threatening developments in real time.

This could represent a VERY valuable adjunctive service for home health care patients, at close to zero cost. "Blogs" are available free of charge on a wide variety of websites. Any HIPAA-related concerns could be adequately addressed by using a secure site which allows password-protection of medical blogs and providing said password only to patient and healthcare professional.

I've got to run. My ID doc STILL has not called me back.

Thanks again to ALL who have responded. You can consider this my consent to use any of my pictures as training aids.

Warm Regards,


p.s. Here is alink to the PictureTrail site where I have been placing "picc pix" since the first day of insertion:

24 hours post PICC removal

36 hours after picc removal


Halle Utter
This looks like it could be
This looks like it could be lymphatic fluid.  While rare, I have seen a case where the insertion process nicked a lymphatic vessel in the arm and continuously oozed yellow serous like fluid.  This does look a bit more opaque though, and the skin is awfully irritatated.  Did anyone culture this stuff?  Hope you get better! 

Hallene E Utter, RN, BSN Intravenous Care, INC

Nothing was sent for

Nothing was sent for culturing, as the nurse came out on a Sunday (I asked if she had taken the line itself to be cultured, and she let me know that wasn't possible since it was a Sunday). I'll ask tomorrow at the hospital about the possiblity that the exudate is actually lymphatic fluid. Thanks for the headsup on that, btw.

My infectious disease doc FINALLY returned my call (about 28 hours after I first placed the request for a return phone call with the message that the infected PICC was removed).

He told me he thought I "probably did not have a bloodstream infection", and that my current 99.5 fever "wasn't high". I hope he's right. I really do.

He ordered a new PICC. They'll place it tomorrow.

Thanks to all the professionals here who have offered encouragement and feedback. I realize that it might be a little uncomfortable to have a patient posting in this forum. I really value all of the input I have received here.



p.s. Is it accurate to say that the risk of bloodstream infection from an infected PICC is very low if the infected line is removed?

p.p.s. Thank you for the well wishes for my health. I sure hope I get better, too. Lyme disease is hard enough without these PICC issues. For the past 2 days, I've had zero treatment, as far as the IV antibiotics for the Lyme (no way to administer). I don't  know how to do anything to help my arm other than hydrogen peroxide (it is still completely disgusting and VERY VERY itchy and nasty). My doc did order a new PICC, but I am having VERY serious reservations about doing it, given the problems so far.  


Thanks for the info in re:

Thanks for the info in re: chloraprep. Seems like a reasonable theory to me (I wonder if that could be why I was so SUPER ITCHY just after dressing changes). I will see if there is any Chlorhexidine in my supplies box and test that out in a small, incospicuous area of my skin to see if that could be the culprit. I will inquire about biopatch, as well, if it turns out that the chlorhexidine itself is not to blame .

I just got home from getting a new PICC inserted. I must say, I would choose the ultrasound guided method any day of the week (no need for the peripheral IV to do the contrast dye). I am all for fewer sticks (but then again, I'm a self-proclaimed pansy!). The folks at Hunterdon Medical Center (who placed the PICC for me a few hours ago) were kind enough to give me an extra dressing of the type they used. If that one works out, perhaps we can get something similar to use on a regular basis. It's not transparent, though, is my only hestitation (basically looks like a giant piece of cloth-like gauze).

Thanks again for the info!



p.s. Right now am trying hydrogen peroxide and a topical antifungal to see if it will help clear up the rash. 

Looks like it may be fungal
Looks like it may be fungal to me.  How long has it been sutured in?  I prefer statlocks that can be changed and the area cleaned.
I think you're right,

I think you're right, Allenmob, that the skin infection is probably fungal. My nurse suggested this, and it seems to be improving with topical antifungals. I wonder if there is anything else I can do to speed up the healing, as it is getting pretty warm here (and my a/c is broken), and my arm still looks nasty in short sleeves.


As for the sutures, they were in for the whole time (about a month). I had requested that they be removed (on a couple of occaissions, actually), but my nurse refused (not 100% sure why).


This time around, though (I got a new PICC last Tuesday),I had my doc specifically order NO SUTURES, so I have a statlock. I have a longstanding (admittedly unreasonble) fear of sutures, and it grossed me out to look at them, so I'm pretty happy about this statlock situation!


My new one is on the right arm this time (bottom picture). It looks a wee bit pink around the insertion site, and has some scab-looking material around it, but doesn't look too bad overall to me (at least compared to the last one). My arm was hurting a good bit the first couple of days, but I suppose that happens sometimes. Not sure why it seems so achey (last one wasn't achey at all). Hopefully, this time around will be much better.


Thanks for your input,


First picc 6 days post removal


2nd PICC 5-12-07


Diflucan might help, but
Diflucan might help, but that is between you and your MD.
Thanks, Allenmob! I'll be

Thanks, Allenmob! I'll be sure to ask him about the diflucan.

One more little thing. Is a swelling of about 4 cm pretty minor or something which is of concern? I noticed that my arm looked puffy, so I measured it. It was 24cm on Tuesday (when the new PICC was inserted), and about 29 cm now. Not sure if that is significant or to be expected. Your thoughts?

Thanks again,



UPDATE: Went to the ER. They pulled the 2nd PICC (was in all of about 5 days). I'm more disgusted than I can possibly hope to communicate. Moron ED doc didn't even know what a PICC really was (thought it was a midline). Rocket scientist didn't even bother to measure it when he pulled it out (my husband insisted, so he reluctantly pulled it out of the trash). This whole PICC fiasco has been nothing but trouble from day one.

Michele- I am sure I speak


I am sure I speak for all of us when I say that I am very sorry for your bad experiences with your PICC lines. To have had so many complications is truly the exception rather than the rule. It would be unfair to speculate why things went wrong--sometimes negative outcomes happen despite everything having been done properly.

At this point,you still have some issues that need to be addressed. The swelling of your arm that you described could be an indication of a clot in the vein the PICC was in. Make sure your MD knows about it. He may order further work-up,however the basic treatment would be elevation of the arm and local warmth (heating pad on low setting). Also keep measuring the arm for changes in circumference.

There is also the issue of your skin problems. Either Infectious Disease or Dermatology could diagnose or rule out a yeast/fungal infection. However,if it were me,I'd want to see Derm for a more thorough evaluation--it could well be a combination of factors that may or may not include something fungal.

I thank you for sharing your photos and story with us and hope that things go better in the future for you.




Thank you, David, for your

Thank you, David, for your kind words and especially for the helpful info.

I have an appointment with my Lyme specialist on Monday. I will be sure to ask about the PICC sites. If he can't determine definitively what the skin issue is, I guess I will head off to a dermatologist.

The left one sure looks a lot better to me. Parts of it are turning more brown now (except right after I shower, when it turns red for a bit), except where the sutures were.I can see now where the sutures were looks different to me (sort of puffed up a bit) than the surrounding tissue. I'm guessing that goes away with time? I hope so.

Although the right arm is still swollen (as is the left), the skin looks better to me. The pink part seems concentrated directly under where the statlock used to be. I wonder if they make some sort of hypoallergenic medical adhesive. It seems I have the most trouble where the adhesives contact my skin.

I've attached a couple more pictures which users are welcome to use for training purposes. If I find out Monday what sort of skin infection this is, I'll let you know, so that maybe you could use that for training purposes, as well.

Thanks again to everyone for your input.


p.s. If any of you have a moment, could you tell me how long it tyipcally takes for a fungal skin infection to clear? Also, is there any possibility that this could be a staph type infection?


Left PICC site 5-17-07PICC site: Right 5-17-07

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