Morning everyone:
I need your advice because we have a strange case and I would know if someone have been something similar.
We have a patient with a Picc line. This line was cannulated 3 moths ago and we have to perform the care and change dressing every day because it has a serous exudate in the insertion point. We did all kind of test and the PICC lines it´s OK and without infection sings and it works perfectly.
My question´s:
Is it possible that we accidentally puctured a lymph vessel and this exudate could be lymph?.
On the other hand if someone have this experiencie, I need your help to manage this situation please. what we should be done with this PICC line?. How can we do care and maintenance? ....
thanks
How do you know this is serous fluid, meaning only serum leaking from the site? Any testing on it?
This could be vein damage producing vein thrombosis. It could be damage to some other anatomical structure like a lymph node. It could be catheter damage causing infusing fluid to leak.
The point is, without some type of collection and testing, you really don't know what it is. But you do know it is not right for this to be happening. You could have a contrast study done but that could allow contrast to extravasate, which is a vesicant. Consult with radiology about that first.
I would have taken it out long before 3 months. How much longer is the infusion therapy needed? What type of therapy is it? Is tip correctly positioned? Any other signs or symptoms, complaints of anything from patient? 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
I would agree with Lynn, the line should be replaced. Was an ultrasound done to rule out a thrombosis? When we see fluid at the insertion site that is the same character as what we are infusing, we suspect a thrombus. Regardless, having a constantly wet insertion site is an infection waiting to happen. Lymph fluid tends to be milky in appearance.
Wendy Erickson RN
Eau Claire WI