WHAT IS A PERMCATH?
A permcath is a long, flexible tube that is inserted into a vein most commonly in the neck (internal jugular vein) and less commonly in the groin (femoral vein). This type of ventral venous catheter is tunneled under the skin for a few centimeters usually on the chest before it enter the neck vein. This is done when the catheter is going to be in place for long term (ie. greater than two weeks). If the catheter is not being left in long term than a Vascath can be placed which is a nontunneled central venous catheter that directly enters the neck or groin vein without having to be tunneled under the skin. The reason for the tunneling of the permcath is that it had been shown that catheters tat are tunneled under the skin before entering the vein have a lower risk of becoming infected or colonized by bacteria. This is partly accomplished by tunneling under the skin and because the permcath has a cuff, which is not visible and is in the tunnel under the skin allowing the subcutaneous tissue to grow into the cuff essentially creating a barrier for bacteria. This cuff once in place is also responsible for keeping the catheter stable so that it does not easily slide out as well as protecting it from infections.
These tunneled central venous catheter can be left in place for as long as one year and provides permanent access in patients. However despite being considered permanent the longer they are in place the greater the risk that they will eventually become infected. This is why most physicians will try to use these catheters as a bridge for finding other means of even more permanent dialysis such as an arteriovenous fistula or graft.
Permcaths although they appear to be one tube actually have two hollow bores. One part of the tube is responsible for carrying the blood to the dialysis machine and the other one carries it back from the machine to the body.
Permcath, better known as the dialysis catheter or hemodialysis catheter is used in a variety of cases. Here are a few indications;
- Regular hemodialysis to treat kidney failure- permcath avoids multiple catheter insertions and serves as a permanent catheter for dialysis.
- Route for plasmapheresis.
- Frequent blood sampling
- Administration of drugs and fluids during long-term treatment
- Administration of caustic medications (chemotherapy) that may harm peripheral veins
- A route for TPN and blood products in special cases
All your blood tests should be done a day before the procedure has to be carried out. Before beginning with the insertion, anesthesia is induced to make the procedure painless. The doctor will then access the jugular vein and introduce a guide wire into the superior vena cava (svc) exactly where catheter enters the skin. Your doctor basically creates a tunnel this way, through which the catheter is threaded under the skin. Along with the cuff that keeps the catheter in its place, a few stitches will be given and scar tissue will form later to help keep the catheter in place. The 45 minute procedure will be followed by an imaging technique to make sure that it is lying in the right place.
Permcatheter removal is as important as its insertion and needs a professional to take care of it. Indications of permcath removal are;
- Access no longer required, either due to completion of renal treatment or due to the availability of a better alternative
- Catheter related infection
- Persistent catheter infection
- Damaged or inappropriately functioning catheter
Removal of this tunneled dialysis catheter requires local anesthesia induction followed by a small surgical incision to release the catheter cuff if it has been there for more than 3 weeks. For a cuff that has been in the place for less than 3 weeks, simple traction is enough to pull it out.
Line removal should be planned on a no-dialysis day or before dialysis and should be carried out after conducting blood tests and ruling out bleeding disorders or intake of anti-coagulants.
Aseptic techniques should be employed while removing it. These techniques include hand hygiene, barrier precautions and chlorhexidine preparation.
PERMCATH CATHETER COMPLICATIONS
There are a number of complications that may arise due to placement of this permanent catheter for dialysis. However, a professional could avoid most of these by following proper protocol and aseptic techniques. These complications are;
- Arterial puncture (less likely under ultrasound guidance)
- Cardiac arrhythmias
- Air embolism
- Cardiac tamponadE
With a permcath inserted, you have to be extra careful and avoid vigorous activities like swimming. Make sure that the dressing over the sites is always clean and dry. A small shower is always preferred to a bath in which the dressing soaks. The dressing should always be dry and secure, so that it holds the catheter in position firmly and the risk of infection is reduced.
Other than this make sure you abide by your surgeon’s instructions and go through the guidelines thoroughly. If you feel pain, swelling, redness or any other unusual symptom, contact the doctor immediately.