What is a Chyle leak?
A chyle leak, chylothorax or chylous effusion, is a lymphatic flow disorder that occurs where there is lymph drainage where it should not be. It occurs generally after surgery or trauma. There is a appearance of milky, white serous or serosanguineous fluid that is rich in triglycerides.
Why is it Serious
The consequences of chyle leaks can lead to nutritional deficiencies because chyle carries fat soluble vitamins. It can lead to immunosuppression because it carries WBCs and proteins crucial to immunity. It can also cause fluid and electrolyte imbalances, lymphedema, infections and fistula formations.
Treatment
Treatment for chyle leaks include conservative treatment which includes dietary changes and medications to reduce chyle production. Also, fluid and electrolyte replacement. Surgical repair is sometimes required for high-output leaks and when conservative measures do not work.
Enteral Feeding with Chyle Leaks
If your patient cannot take a po diet, enteral feeds may be necessary. The primary goals are to feed your patient an adequate amount of nutrition and avoid fat but also avoid essential fatty acid deficiency. There are some enteral formulas that are very low in fat that may be usable. I had a patient that was still having high output with our lowest fat enteral product. We had 2 options; change to PN or use a fat free oral nutrition supplement. We tried the FF ONS and actually had good outcomes.
Case Study
I do not remember all of the specifics of this particular patient regarding anthropometrics and past medical history other than he had a chyle leak from a thoracic surgery and he was intubated for several weeks. The very progressive physician wanted to avoid PN, so we tried enteral feeds. Our first attempt, we used a low-fat peptide formula This resulted in increased output from the chyle leak. Our second attempt was to use our clear liquid oral nutrition supplement that is fat free. Generally, we use a closed system for enteral feeds, but because this product came in bottles. we had to use bags that were filled manually but the nursing staff. I believe at the time we used a product called “Resource Fruit Beverage”. We infused it at 75 or 80 ml per hour and it provided adequate protein but not quite the calorie needs. Over the several week period, we infused lipids several times to prevent EFAD. This worked fairly well. The patient had a reduction in the chyle leak to the point that is had stopped. He was eventually able to be changed to a standard enteral feeding formula with good tolerance.
If anyone has any questions, drop a comment, thank you so much!