When kidneys no longer function effectively, dialysis becomes necessary to filter waste and fluids from the blood. For this life-sustaining procedure, reliable vascular access is essential. Several types of vascular access exist to facilitate dialysis. One type is the permacath, a specialized device providing consistent, long-term access for dialysis.
Understanding the Permacath
A permacath, also known as a tunneled dialysis catheter, is a flexible tube surgically placed into a large vein. This catheter has two lumens, allowing for efficient blood flow during dialysis. One lumen draws blood to the dialysis machine for cleaning, while the other returns filtered blood to the patient.
The catheter is ‘tunneled’ under the skin, inserted beneath the skin and guided to an exit site on the chest wall. This tunneling secures the catheter and reduces infection risk. A cuff under the skin anchors the catheter as tissue grows around it, providing stability and acting as an infection barrier.
When a Permacath is Needed
A permacath is used for dialysis access in specific situations. It serves as a long-term solution when preferred vascular access options, such as arteriovenous (AV) fistulas or grafts, are not feasible or have failed. AV fistulas, which connect an artery directly to a vein, are generally preferred due to their durability and lower infection rates. However, they require weeks or months to mature before use.
In contrast, a permacath can be used immediately after placement. This makes it suitable for patients requiring urgent dialysis or awaiting maturation of a new fistula or graft. It also serves as long-term access when a patient’s blood vessels are not strong enough for a fistula or graft, or when other access attempts have been unsuccessful.
Placement and Daily Care
Permacath insertion is a minor surgical procedure, typically performed under local anesthesia. A healthcare professional, often guided by imaging, inserts the catheter into a large central vein, usually in the neck. The catheter is then tunneled under the skin to an exit site on the chest, with the tip positioned near the heart for optimal blood flow. The process generally takes 15 to 60 minutes, and patients often return home the same day.
Proper daily care is important to prevent complications and ensure the permacath functions. Patients and caregivers must maintain hand hygiene before touching the catheter or its exit site. The area around the catheter exit site must be kept clean and dry. Dressings should be changed regularly, typically weekly, or if they become loose, damp, or soiled. Healthcare providers give specific instructions for dressing changes, often involving sterile techniques to minimize infection risk. During dialysis, medical professionals manage the permacath connection to the dialysis machine, ensuring proper blood flow and system integrity.
Living with a Permacath
Living with a permacath requires adapting daily routines to protect the catheter and monitor for issues. Patients should avoid activities that stress the catheter or its insertion site, such as heavy lifting or strenuous exercise, especially during the initial healing period. Keeping the catheter and its dressing dry is also important. Swimming and submerging the catheter in water should be avoided to reduce infection risk.
Patients should watch for signs of infection, including redness, swelling, warmth, pain, or unusual discharge at the catheter site, along with systemic symptoms like fever or chills. Difficulties with blood flow during dialysis, such as decreased flow rate or frequent alarms, could indicate catheter dysfunction. Report any concerns to healthcare providers immediately. Permacaths are designed for long-term use, often remaining in place for months to over a year. They are eventually removed if no longer needed or if complications arise. Removal is generally straightforward and managed by a medical professional.