A permacath (also called a dialysis catheter, central venous catheter, or temporary dialysis line) is a soft, dual-lumen tube placed into a large central vein. It provides immediate access to the bloodstream for hemodialysis when an AV fistula has not yet matured or when urgent dialysis is needed. While it is called "temporary," permacaths can remain in place for weeks to months if needed.
When is a Permacath Used?
- Emergency dialysis — when a patient presents with severe kidney failure requiring immediate treatment
- Bridge access — while waiting for an AV fistula to mature (6-8 weeks)
- Failed AV fistula — when existing access has clotted or is not working
- Patients who cannot have an AV fistula — due to poor vessels or other medical conditions
- Short-term dialysis need — for acute kidney injury that may recover
Types of Permacath Placement
Internal Jugular (Preferred)
Placed in the right internal jugular vein in the neck. This is the preferred site because it has a straight path to the heart, lower risk of complications, and is more comfortable for the patient. The exit site is on the chest.
Best for: Most patients, lower complication rate
Femoral Vein
Placed in the femoral vein in the groin. Used when jugular access is not possible or for very short-term use. Higher infection risk and less comfortable for the patient. Not ideal for repeated use.
Note: Higher infection risk, used as last resort
The Procedure
Preparation
The procedure is done under local anaesthesia. The neck or groin area is cleaned and draped. Ultrasound is used to visualise the vein and guide needle placement.
Needle Access
A needle is inserted into the vein under ultrasound guidance. A guidewire is passed through the needle into the vein.
Dilation
The tract is dilated (widened) using dilators to accommodate the catheter. This step is usually painless under local anaesthesia.
Catheter Placement
The dual-lumen catheter is threaded over the wire into the vein. The tip should be near the right atrium for optimal blood flow. Position is confirmed by X-ray.
Securing
The catheter is sutured to the skin and covered with a sterile dressing. The procedure takes 15-30 minutes.
Care Instructions
- •Keep the exit site clean and dry — change dressing as directed
- •No swimming or submerging in water until the catheter is removed
- •Cover the site with a waterproof dressing when showering
- •Do not pull or tug on the catheter
- •Report any signs of infection — redness, swelling, pus, fever
- •The catheter caps ( hubs) must be cleaned with antiseptic before each dialysis session
- •Do not use the catheter for anything other than dialysis (no blood draws, medications)
- •Carry an emergency card identifying you as having a dialysis catheter
Removal
Once an AV fistula is mature and ready for use, or when the catheter is no longer needed, it is removed. The patient lies down, the dressing is removed, and the catheter is gently pulled out. Pressure is applied to the exit site for 10-15 minutes to prevent bleeding. A sterile dressing is applied. The site usually heals within 1-2 weeks.
Complications
- Infection — the most common complication. Can be local (exit site) or systemic (bloodstream infection/sepsis)
- Catheter-related bloodstream infection (CRBSI) — requires catheter removal and antibiotics
- Thrombosis — blood clot formation around the catheter
- Stenosis — narrowing of the vein due to catheter irritation
- Catheter migration — the catheter moves from its original position
- Air embolism — rare but serious if air enters the vein
Need a Dialysis Catheter?
Dr. Rajesh Goel inserts permacaths under ultrasound guidance with meticulous sterile technique to minimise infection risk. He also plans for timely fistula creation and catheter removal.