What is a Permcath for dialysis?

Important points to know about Permcath

Most doctors recommend a Permcath to conduct dialysis. Permcath is a type of tunneled catheter used for hemodialysis. It is inserted through one of the veins leading to the heart. Such treatments are generally conducted when the need is for a long time.

What is a Permcath for dialysis?

Permcaths or tunneled hemodialysis catheters are double-lumen catheters. It has a polyester cuff placed at around 1-2 cm on the chest from the exit site underneath the skin. Generally, it is made up of silicone or thin polyurethane-like polymers that have proved to be less thrombogenic than those used for non-tunneled catheters. They are also found to be more flexible and softer than the non-tunneled ones.

What type of catheter is a Permacath?

There are two types of catheters- tunneled and non-tunneled. A permcath is a tunneled catheter. It is a flexible, long tube that is inserted into the vein. Most doctors prefer to insert it either through the neck region (into the internal jugular vein or subclavian vein) or through the groin region (femoral vein) or rarely directly to inferior vena cava vein . In the neck region insertion, the permcath is tunneled under the skin in the chest region. In the groin region insertion, the tunnel is made under the skin, especially in the mid-thigh region. 

Permcath catheters are used when their need is for long periods (more than a few weeks). If the need is for a shorter duration, non-tunneled catheters like the Vascath or Quinton are used.

Is a Permacath a CVC?

CVC stands for the central venous catheter. It is inserted into the vein connected to the central vasculature. It can be both tunneled and non-tunneled. Permacath is a tunneled catheter commonly used for hemodialysis. It is inserted into the internal jugular vein or the femoral vein according to the patient’s case and needs. Therefore, it can also be considered a central venous catheter or CVC.

How is a tunneled catheter inserted?

To insert the Permcath, a special intravenous line is created in the blood vessel, especially in the upper chest or the neck region just beneath the collarbone. The groin region is also preferred. Such kinds of dialysis treatment are preferred for a short time. Through this tunnel, the catheter is then threaded till it reaches the right atrium of the heart.

The catheters are places along with fluoroscopic and ultrasound guidance to monitor the threading process. Local anesthesia, with or without sedation, is administered to the patient. The entire operation takes place either in an angiographic setting or an operating room that is properly equipped for such treatments. 

Fluoroscopy is required for proper guidance during catheter positioning. The surgeons can directly image the dilators and wires to reduce the chances of injury. Almost 95 to 100 percent accuracy is achieved in catheter positioning with the aid of this technique. In the absence of fluorescent support, catheter malposition occurs in 25 to 40 percent of the cases. 

Such a tunneling process is important since it reduces the chances of infection. Moreover, it allows the catheter to remain in the tunnel for long periods (around twelve months). Sterility is maintained by all the physicians, nurses, and X-ray techs during the operation procedure. They might also conduct the sedation process using Chlorhexidine or Lidocaine solution. Sterility is also maintained during dressing after the procedure is over. The entire operation takes around 15 to 45 minutes.

Where is a tunneled dialysis catheter placed?

The tunneled dialysis catheter is generally placed through the neck region or the groin region. During operation through the neck region, the physician chooses the upper chest or neck just beneath the collar bone. The tunnel is directed through the internal jugular vein to the right atrium of the heart. The catheter is placed in this vein.

When the physician decides to operate through the groin region, they target the femoral vein. The rest of the procedure is similar to that followed during neck region-based operations.

How long does a Permacath last?

In general, the Permacath operation lasts for about 15 to 45 minutes. It is similar to a laparoscopic procedure with local anesthesia and sedation if necessary. The entire process is monitored through a fluoroscope for the exact positioning of the catheter. The cuffs are positioned just beneath the subcutaneous layer of the skin to hold the catheter in position.

How do you remove Permacath?

The removal process of a Permacath holds the same importance as its insertion process. People prefer to get them removed when 

  • They are no longer required.
  • Infection due to catheter.
  • The catheter is not functioning properly.

To remove the Permacath, a small incision is made to release the catheter cuff, provided it has been inserted for more than three weeks. If the duration is less, then they can be pulled out by a simple traction process. Local anesthesia is required during the entire procedure. 

It is important to plan such removal either before dialysis or when dialysis is not planned. Certain blood tests are needed to be conducted to ensure there are no bleeding disorders, or the patient has not taken any anti-coagulant.

What is a tunneled catheter vs. a non-tunneled?

It is quite clear till now what a tunneled catheter is. A non-tunneled catheter does not require the formation of a tunnel either in the neck or in the groin region. They are directly inserted into the body. Such a non-tunneled catheter is also known as Quinton or Vascath. 

Most physicians prefer the tunneled catheters as it reduces the chances of infection. The entire tunneled catheter procedure is conducted aseptically. Another advantage of the tunneled catheter over non-tunneled ones is that it comes with a cuff that holds the catheter in place beneath the skin. They are also more flexible and softer than non-tunneled catheters.

Non-tunneled catheters are generally used for shorter durations, while the tunneled ones are used for longer durations.

How long can a tunneled dialysis catheter stay in?

Generally, tunneled dialysis catheters are employed when it is meant to stay inside the body for a long period of time. This period ranges from a few weeks to even a year.

What is a non-tunneled dialysis catheter?

A non-tunneled dialysis catheter is also known as a Quinton or Vascath. These catheters do not require the formation of a tunnel beneath the skin and through the veins. They are inserted directly through the neck or groin region. Since they pose an increased risk of infection, they are used for a few days inside the body.

How long can a non-tunneled catheter stay?

A non-tunneled catheter is generally not preferred to be kept inside the body for long. They are generally used for a few days (up to 4 to 6 weeks).