The cloudy drainage from this implanted port presented several weeks after implantation. It was inserted via the left subclavian vein without incident during the surgical procedure. The incision had healed and sutures had been removed. When accessed with a 20-gauge port access needle, this cloudy fluid began to leak from the puncture site. More exudate continued after removal of the needle.
So what could this be? A serious port pocket infection? Extravasation of the previously infused fluid?
This is chyle – a combination of lymph fluid and free fatty acid from the small intestines. The fluid passes through the lymph system where it enters the bloodstream through the thoracic duct located at or near the junction of the left internal jugular and subclavian veins. A smaller thoracic duct can also be found on the right side.
During insertion of any central venous catheter (including PICCs), these thoracic ducts can be damaged, causing the chyle to leak into the pleural space or externally. In this case, the chyle tracked along the catheter and accumulated in the port pocket. Accessing the port caused the chyle to leak from the puncture site.
Although rare, it is important to be aware of this complication from CVADs. Several articles can be downloaded about this complication. Click these links to learn more.
Chylothorax - A Complication Of Peripherally Inserted Central Catheters
Thoracic Duct Cannulation During Central Venous Catheterization: A case Report
Iatrogenic chylothorax due to pleural cavity extravasation of total parenteral nutrition in two adults receiving nutrition through a peripherally inserted central catheter.
Author: Lynn Hadaway
Lynn Hadaway has more than 35 years experience in infusion nursing and adult education. Her experience comes from multiple acute care settings, healthcare manufacturing, continuing professional education.