what causes PICC line insertion site leaking

[fangguixiao]

My co-worker placed a PICC for a patient who suffers osteomyelitis and needs long term antibiotic. The insertion site started a little leaking fluid after 4 days placed. I did assessment. Pt no c/o pain at insertion site,no redness, no swollen. blood return is very good. I flushed each lumen with 10ml N.S after dressing change, no leaking.External cath is still 2 cm as original . Pt is no hx of kidney problem .I came back to assess it again after two days.The dressing is a little wet . I talked with radiologist . He said doesnot need to do anything at this time, just do dressing change more often, keep c/d/i.

I talked with my co-worker who placed the line. She said probably thrombosis , just take out the line , place another one to another arm.

My question is what causes this leaking ?Can we order ultrasound to confirm it is thrombosis instead of just simply pull out the line?Patient doesnot complain any discomfort. what else action we can take? any input is greatly appreciated. Thanks in advance!!

[IVRUS, BSN, RN]

Yes, my first thought too is, thrombosis of line.. but that is highly unusual in a line that new, even though fibrin sheaths can develop in a matter of hrs (~24).

But it also could be Chyle. This has a greater chance of development if the access was done on the left side, versus right. Check the exudate for glucose, as Chyle is very high in glucose. If there is no resolution to the problem, then I too would remove and replace.

Also thrombosis of a line, without infection, should be treated rather than removed. You are right about that.

[fangguixiao]

Thank you so much IVRUS. The leaking fluid was clear,not like chyle (a milky appearance ,a mixture of lymphatic fluid and chylomicrons).Why it is greater chance to develop chyle if access at left side than right side ? I appreciate your help!!

[IVRUS, BSN, RN]

Namely because the thoracic duct, connects to the left subclavian vein bringing all of the lymph fluid into the blood stream. . Here, one has the primary connection of the lymphatic system to the venous system.

[fangguixiao]

Thank you so much IVRUS. I appreciate your help!