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?
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
Cindy Hunchusky, BSN, RN, CRNI
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, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
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