Please help identify cheesy, tan residue on PICC

[justdeda]

Hello, all

Tonight, I removed a dual-lumen PICC in the upper brachial that was in place for just over 5 weeks. (I never received the info on the PICC, nothing visible on the cath, do not know the manufacturer, but it was not one of the newer Power or PasV types). It came out very easily, but had stuff stuck to it-- a kind of cheesy-looking, pale, tan residue starting at about 5cm proximal to the insertion level, and continuing to about 40cm proximally. The final 10cm were smooth, the end was intact. There was a plug in one of the lumens, tho I had realized that back around week 3, when I was unable to flush it at all. Since the removal was done in the home, I had no way of sending a piece off to any labs. Actually, I have never seen anything like this, and I wondered if anyone had this experience. The stuff looked like it could easily be wiped off, but when I attempted to clean the cath, it stuck tight, coming off with difficulty, and only when I held the cath tightly with gauze to wipe it. There was no particular odor. The insertion site itself was completely dry, no bleeding whatsoever. Was this possibly some kind of venous fat? The patient is a very physically fit 56yo male, trim and athletic, who could easily be mistaken for 40-45yo. He had some localized allergic reaction to the PICC line: itching, very mild distal edema, patchy pink areas here and there near the ins. site treated with oral Benadryl. This was his second line: the first was removed within a week of insertion due to localized erythema and severe itching at the site and about 5cm diameter around it, and took 2 weeks to heal properly after removal.

Would appreciate anything relevant that anyone might have experienced!

Thanks,

justdeda:nurse:

Home IV Nurse

[iluvivt, BSN, RN]

Did the patient have any s/sx of systemic infection or bacteremia? I hav d/ced a few PICCS that were coated with purulent drainage along the length of the PICC as I pulled it out. The fact that this man had some kind of hypersensitivity reaction to a previous PICC and possibly this one leads me to believe that it could be a fibrin build-up....as if his body was trying to wall if off. Does this patient have any autoimmunine disorders? Also wanted to let you know that once a lumen of any CVC is occluded....it should not be left that way. If it is a thrombotic occlusion,Tpa should have been used,,,,,otherwise it puts the patient at an increased risk for infection. PWOs (persistant withdrwal occlusions) where you can instill but not withdraw also need to be treated. I also sent you a private message before I read this and may be able to provide you with some more info....need to rest a bit though before my next shift.

[justdeda]

thanks for the response :) pt asymptomatic of any systemic or even localized infection. the pharmacy to which i was subcontracted declined to permit me to do a TPA at home, but never contacted the MD to have it done in hospital, and recommended i simply stop using that port:rolleyes:. ill remember your words next time it happens! what i found in the occluded lumen upon withdrawal was a flesh-colored piece with a sang-tinged tip. im just grateful the pt phoned me right away, and didnt try to push the flush!!! regarding the odd sediment on the cath...my first thought was indeed fibrin buildup, especially since there was no odor, and the stuff was very regular in consistency (odd clumps) all along the area covered with it. it just didnt really look organic, somehow! i have been wondering if there are piccs that have some kind of coating that helps to block off the vein, that might have deteriorated into little, irregular clumps over the course of treatment. i was thinking this might explain both why the site didnt bleed, and why it was so stuck to the catheter that it required real persistence to wipe the cath clean, and even then, not completely clean. have read your note and replied, and thanks for your input.

justdeda

[bobnurse]

Sounds like fibrin and possibly biofilm build up.

IF you go to the cathflo website, they have a pretty good base of education, powerpoints and so forth that describe this.

I also agree with the above poster that the line should have been fixed or removed.

Occluded lines lead to infection.

[accessqueen]

Agree, that this is fibrin sheath. Some people are virtual firbrin factories and some people can have a line forever and it pulls out clean as a whistle.

[justdeda]

Never seen it before or since, but then...now that I've seen it, I will know it next time (-:

Thanks