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Possible Lymphatic access with L chest port
One of our nurses called me to the oncology floor today to evaluate a port she had just reaccessed after being unable to remove tpa.  The port was very deep and unstable...difficult to access.  She used a 1" needle and it really needed a 1 1/2".  She was then able to withdraw and flush...but there was no blood return, just a thin, cloudy fluid in copious amounts..which she reinjected, then called me.  After evaluating it, I thought it was in the lymph system.  I'd seen this with subclavian lines a couple of times when I worked in ICU.  The catheter itself wasn't in the lymph channel, because I reaccessed and was able to obtain blood return.  I think the nurse missed the port and accessed a lymph node or channel.  The patient seemed totally unaffected. Has anyone ever had this happen?
lynncrni
Yes, but I don't think she
Yes, but I don't think she actually hit the lymph gland or node. Was this port placed on the left side of the chest? If so, the vein entry point was probably close to the point where the large thoracic duct joins the left subclavian vein. This is where all the body's lymph fluid drains back into the bloodstream. If this junction was damaged during catheter insertion, there could be lymph fluid draining into the port pocket. She may not have hit the port body but I doubt she hit a node or gland directly. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

clhunchusky
Lynn, how is this resolved?
Lynn, how is this resolved? If indeed it was damaged on initial insertion, does it seal itself off or resolve on its own and if not, what would clue you in that this is most likely what's happening and that it would need to be removed? Thanks.
lynncrni
The catheter should be

The catheter should be removed because of this damage to the thoracic duct and it usually will not resolve on its own. You can read more on my website - www.hadawayassociates.com, Clinical Articles, Catheter-related Chylothorax

Lynn 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

[email protected]..
Very interesting article,

Very interesting article, Lynn.  I'll follow up on this patient.  I thought the nurse had accessed a duct because there was no swelling of the chest at or near the port.  I palpated and pressed fairly hard all around the port before and after I deaccessed it.  When I reaccessed, I got a good, rapid blood return without apparent dilution or cloudiness.  When I aspirated, using the other nurse's access, I got a large amount of cloudy fluid...and it just kept coming with aspiration.

  I guess, since the port was very deep and mobile, I could have missed any signs of leakage into the port pocket.

T. Nauman RN, CRNI

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