From the Guidelines
A permacath, also known as a permanent catheter, is a type of central venous catheter designed for long-term use, typically lasting several months to years, and is defined as a long-term catheter access used for more than 3 months in the absence of a maturing permanent access, such as a graft or fistula 1.
Key Characteristics of Permacaths
- They consist of a soft, flexible tube that is surgically inserted into a large vein, usually in the neck, chest, or groin, with the tip positioned near the heart.
- Permacaths have two lumens (channels) that allow for simultaneous blood withdrawal and return, making them ideal for hemodialysis patients who require regular vascular access.
- Unlike temporary catheters, permacaths are tunneled under the skin before entering the vein, which reduces infection risk and provides greater stability.
- They also feature a cuff that promotes tissue growth around the catheter, further securing it in place and creating a barrier against bacteria.
Maintenance and Risks
- Permacaths require regular maintenance including sterile dressing changes and periodic flushing with heparin or saline to prevent clotting.
- While permacaths offer immediate and reliable access for dialysis, they carry risks including infection, clotting, and vein damage, so they're typically used when arteriovenous fistulas or grafts aren't viable options or while waiting for these preferred access methods to mature, and should be used in less than 10% of patients as a permanent dialysis access 1.
Clinical Guidelines
- The use of permacaths is guided by clinical practice guidelines, which recommend their use as a last resort due to the associated risks and complications 1.
From the Research
Definition of Permacath
- A permacath, also known as a permanent catheter, is a type of vascular access used for hemodialysis in patients with end-stage renal disease (ESRD) 2, 3, 4, 5.
- It is a double lumen tunneled catheter that is inserted into a vein, typically in the neck or chest, and is used as an alternative access when other modalities, such as arteriovenous fistula (AVF), are not possible 2.
Indications for Permacath
- Permacath is used as a bridge to renal transplant or AVF maturation 2.
- It is also used in patients with multiple access failures who require hemodialysis 4.
- In some cases, permacath may be the most appropriate option for patients to meet their goals of care 6.
Placement and Complications of Permacath
- Permacath can be placed in the internal jugular vein, external jugular vein, or femoral vein 2, 3.
- Complications of permacath include infection, thrombosis, hemorrhage, migration, dislodgement, leakage, kinking, and chronic venous stenosis 4, 5.
- In rare cases, permacath can cause endovascular endocarditis, a serious infection of the heart 5.