Perm Cath

In chronic kidney failure one has to undergo dialysis multiple times. The most easy access is an AV fistula (in the arm or forearm). However, fistulas may fail or not function. In these cases, a catheter placement may be required for dialysis.

What exactly is a dialysis catheter/hemodialysis catheter/HD catheter?

A dialysis catheter is a plastic tube which is inserted inside your body through one of the major veins of your body, either in your neck or groin. It has 2 ports for inflow and outflow where in blood can be withdrawn, externally dialysed and then flushed back into your body. This catheter can be either temporary (which lasts for a few weeks) or permanent (lasting from a few months to years occasionally).

What exactly is a tunnelled dialysis catheter/permanent catheter or Permcath?

As the name suggests it is a catheter placed permanently hence called a perma-cath; however permanent does not mean lifelong. These catheters generally work from a few months to years. This is a special tube placed commonly in neck vein reaching up to your heart for access of your blood stream for longer duration. It may rarely be placed in your groin as well. It is called permanent because it has a cuff which gets fibrosed in your skin and keeps the catheter in place. This cuff also prevent infection getting transmitted via the catheter. It is called tunnelled because around 7-10 cm of the tube is placed beneath your skin for permanency and to prevent infection (therefore the word tunnel).

It’s usually placed in your neck veins (right side preferred over the left). The tunnel is made in the anterior chest wall. One end of the catheter enters your body from base of neck and into the neck veins. The external opening is placed along chest wall after creating tunnel under your skin and comes out through the side of your chest. If placed in the groin, left groin is preferred over right.

Pre Procedure Preparation

• Your doctor will inform you all the pros and cons about the procedure.
• Informed consent will be taken after detailed explanation of the procedure to you.
• Some pre procedure blood investigations (CBC, PT/INR) to know everything is fine.
• Fasting for 6 hours for food and 2 hours for clear liquids is required.
• Shaving of chest is required.
• Ideally you need to be dialysed a day prior using another access.
• Serum electrolyte tests may be required after the dialysis.
• If all is well, then permanent catheter can be placed directly without dialysis.

Procedure

• You will be taken to DSA /Cath lab Angio Suite for the procedure.
• You will be taken on operation table for the procedure, your position will be dependent upon the vein your doctor is going to access.
• In most of the cases where neck vein is the target, patient will be lying on their back.
• Mostly the right neck vein will be preferred. IV cannula will be placed. Pulse oximeter will be attached. BP cuff will be placed.
• Doctor will give you local anesthesia to numb the area of the neck to reduce pain.
• A needle will be inserted in your vein over which a sheath will be placed.
• After numbing the skin, a 10 cm tract will be created on your chest.
• Using both USG and fluoroscopy, the catheter will be placed from the chest though the sheath and into your neck veins.
• Procedure will last for approximately 30 minutes to 45 minutes.
• Tight compression dressing will be placed to prevent bleeding and infection.
• The catheter can be used directly after placement for dialysis.

Post Procedure

• You may feel some pain. This will resolve on its own.
• The permcath is ready to use as soon as placed for dialysis.
• Rarely minor bruising may ensue, requiring compression dressings/sand bag placement.

No procedure can be absolutely risk free. Chances of catheter getting infected, is there. This depends on usage. If infected, it will require changing of the catheter. Chance of Permcath blockage due to fibrin sheath or clot is also possible. If that happens, it will require placement of a new Permcath.

When to seek medical attention after permcath insertion?

The following requires attention:

• Fever with chills
• Extreme pain
• Drop in BP or saturation
• Permcath not functioning
• Pus discharge from the skin entry site