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Mats Stromberg
Lymph leakage?

Hi all,

had a patient (male in his twenties) with newly placed PICC. He had no pain or other complaints about his PICC, other than that the dressing got soaking wet all the time. He needed daily or more dressing changes. He had no CRP elevation, no infection symptoms. As we did not know what it was the line was pulled and we did not dare to place another one. I got hold of a vascular surgeon today and he thought it was lymph leakage from accidental lymph vessel puncture at PICC placement. He said it would probably have taken up to two weeks for the leakage to stop and that it seldom gets infected if you can keep up with the dressing changes. Has anyone seen this? Do you agree on lymph leakage? Could we have made the leakage stop faster with any kind of intervention? Can you distinguish lymph vessels on the ultrasound? Would it be OK to place a new PICC in this patient? Any other input from anyone?

Thanks from Stockholm 


We recently had this
We recently had this situation also.  Middle aged male on Q12hr IV meds, with clear leakage requiring frequent dressing changes.  We talked with the doctor and thought may have been lymph fluid also.  Ended up removing PICC line and pt was switched to oral meds.  Would be interesting to find out from any interventional radiologists.
Terry Hall
I have had several patients
I have had several patients who have had this complication. The first pt., a young man, required almost daily dressing changes for a two week period, the patient's physician refused to give an order to d/c the PICC line. The second pt. was an elderly man whose drainage was minimal and  eventually subsided over a two week period. I believe this complication of PICC placement is probably more common than is fully appreciated at this time. Both pts. had their PICC placements with MST and ultrasound in the upper arm.
Mats Stromberg
OK so maybe we could have


so maybe we could have waited a couple of weeks if the frequent dressing changes could have been arranged. Also I think it seems it should have been possible to replace the PICC with a new one inserted at not the exact same location (how much bad luck can you have, hitting a lymph vessel again...). Anyone knows if you can see the lymph vessels on US? Anyone know of any way to make the drainage stop quicker?


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