Periphally inserted central catheters—a ‘serous’ complication

Peripherally inserted central catheter (PICC) placement in the upper arm appears to have led to an increased incidence of the inadvertent puncture of lymph vessels, which transport lymph fluid around the body. The fluid flows from the lymph vessel in the arm, through the subcutaneous tract created by the PICC, accumulating in discharge of serous fluid at the exit site. The symptoms may be minimal or excessive and currently there are no published data or guidance as to how to manage this complication. Possible management strategies are proposed in this article. They involve the assessment of the amount and persistence of the discharge, with removal indicated when symptoms persist or when the volume is excessive.