From the Guidelines
Yes, a permacath is a tunneled dialysis catheter. It is a type of central venous catheter specifically designed for hemodialysis access that is surgically placed with a portion of the catheter tunneled through subcutaneous tissue before entering a central vein, typically the internal jugular vein. The tunneled portion helps reduce infection risk by creating distance between the skin entry site and the vein entry site. Permacaths have dual lumens to allow simultaneous blood removal and return during dialysis treatments, and they contain a Dacron cuff that becomes embedded in the subcutaneous tissue, providing both stability and an additional barrier against infection.
Key Characteristics of Permacaths
- Surgically placed with a tunneled portion through subcutaneous tissue
- Dual lumens for simultaneous blood removal and return
- Dacron cuff for stability and infection barrier
- Typically used for weeks to months while awaiting maturation of more permanent access options
Importance of Catheter Care
Patients with permacaths need to maintain strict catheter care protocols to prevent complications such as infection, thrombosis, or catheter dysfunction, as highlighted in studies such as 1. Regular evaluation is necessary to determine if the permacath remains the most appropriate means for dialysis access.
Comparison with Other Access Options
As noted in 1, the KDOQI guidelines suggest that arteriovenous fistulas or grafts are preferred over central venous catheters due to reduced vascular access-related events. However, permacaths are considered a reasonable option in certain circumstances, such as when other access options are not feasible.
Reducing Infection Risk
The use of tunneled catheters like permacaths can help reduce the risk of infection compared to nontunneled catheters, as discussed in 1 and 1. Proper catheter care and maintenance are crucial in minimizing the risk of complications.
From the Research
Definition and Types of Permcath
- Permcath is a type of tunneled dialysis catheter, as mentioned in the study 2 which compared the long-term outcome of Permcath cuffed double catheter and TwinCath uncuffed twin catheter.
- It is a double lumen tunneled catheter used as an alternative access for hemodialysis in End Stage Renal Disease patients, as stated in the study 3.
Characteristics and Placement of Permcath
- Permcath is inserted under ultrasound guidance, with the catheter tip placed in the right atrium via the internal jugular vein, as described in the study 4.
- The procedure involves creating a subcutaneous tunnel over the anterior chest wall, as mentioned in the study 4.
- Permcath can be placed in the right internal jugular vein, left internal jugular vein, or femoral vein, as reported in the study 3.
Complications and Outcomes of Permcath
- Permcath is associated with complications such as infection, dysfunction, and catheter-related bacteremia, as discussed in the studies 2, 5, and 4.
- The study 3 reported major complications including profound hypotension, bradycardia, and cardiac arrest due to left internal jugular vein tear.
- The outcome of Permcath placement can be affected by factors such as catheter management, patient condition, and follow-up care, as mentioned in the studies 2, 3, and 4.