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Sun, 07/15/2007 - 19:19

pallik

pale yellow drainage from new PICC

I have a patient with a new right high upper arm basilic PICC.Â Been changing dressings 1st 48 hours after insertion due to pale yellow- lemon yellow drainage on gauze. No bleeding since 1st dressing change, no purulent drainage.Â My thoughts are that possibly? the lymphatic vessel was nicked, maybe?? Â Anyone else experience this?Â Â Â There's no swelling, PICC is asymptomatic other than the yellow drainage.

thank you, pamÂ

Mon, 07/16/2007 - 07:03

Netty10453

does the patient have

does the patient have edema ? that fluid could be seeping through.

Is there any nurse out there who is willing to share there protocol on extravasation of vesicant drugs, i.e. application of cold, steroid cream , manual injection of antidote.

Mon, 07/16/2007 - 08:28

lynncrni

You said this PICC was

You said this PICC was inserted high in the upper extremity. It is possible that it could have damaged a lymph node and this is lymph fluid. Check the glucose content of this fluid. If it is high, it is probably lymph. You may also need to have a dye study of the catheter and vein. Let us know the outcome please!! 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

Mon, 07/16/2007 - 20:24

pallik

no edema, very thin person

the insertion site is ~ 10cm from the axilla, will follow up tomorrow when i return

Wed, 07/18/2007 - 23:02

Halle Utter

I would bet it's

I would bet it's lymphatic. Saw this once years ago. Yellow clear drainage in fairly large quantity. No pain, swelling. Nothing except this drainage. Pt was thin, and definitely not edematous. PICC was removed. No dye study was done. No complications. New PICC was inserted in opposite arm and therapy completed without sequelae. This PICC was only about 10cm above antecubital, if that. Never seen it since either.

Hallene E Utter, RN, BSN Intravenous Care, INC

Thu, 07/26/2007 - 16:43

Robbin George

Use a culturette swab in

Use a culturette swab in the same way you would culture a wound--The result may tell you more about what it's not that what it actually is

Robbin George RN VA-BC

Mon, 08/06/2007 - 06:30

pallik

patient had no edema.

patient had no edema. patient was discharged and PICC was removed the day after my request. Thank you all for your responses, they were all greatly appreciated! We'll be sure to emphasize this with the MDs if it ever happens again. Has anyone seen any literature on this?

Mon, 08/06/2007 - 08:24

(Reply to #7) #8

lynncrni

If this was lymph drainage,

If this was lymph drainage, I have never seen it with a PICC. However it is well documented in the literature with other CVCs, especially those inserted on the left side. The large thoracic duct drains into the Left SVC, so the left puncture can also damage this duct. I have seen it with a left sided implanted port with the lymph fluid draining from the port pocket. 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

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