Indications for Permcath Insertion

• Chronic Kidney Disease (CKD): Patients needing ongoing dialysis without permanent vascular access.
• Emergency Dialysis: Immediate access needed when fistulas or grafts are not functioning.
• Inadequate AV Access: When arteriovenous access fails or is unsuitable.
• Limited Access Options: When peritoneal dialysis or AV fistulas are not possible.

Procedure for Tunneled Catheter Insertion

1. Preparation & Positioning: Patient is positioned lying down, neck or chest exposed, and skin cleaned with antiseptic.
2. Local Anesthesia: Area is numbed for a pain-free experience.
3. Catheter Insertion: The catheter is placed into a central vein (usually IJV or subclavian) using a guidewire.
4. Tunneling: A tunnel is created under the skin where the catheter is threaded to reduce infection risk.
5. Securing the Catheter: The catheter is stitched and bandaged to prevent movement or infection.
6. Testing: Blood flow is checked to ensure the catheter works well for dialysis.

Advantages of Tunneled Catheters

• Ideal for long-term dialysis access
• Lower infection risk compared to non-tunneled catheters
• Improved patient comfort and mobility
• Reduced chances of catheter dislodgement

Possible Complications

• Infection: Proper care is crucial to prevent CRBSIs.
• Thrombosis: Blood clots may form, blocking catheter use.
• Pneumothorax: Rare lung puncture during insertion.
• Bleeding: Minor bleeding may occur during the procedure.
• Catheter Displacement: Can lead to dialysis failure if not secured properly.

Catheter Care and Maintenance

Proper care helps maintain catheter function and reduces complications:

• Flush catheter regularly with heparinized saline
• Keep the exit site clean and dry
• Change dressings as instructed by your healthcare provider
• Watch for signs of infection: redness, swelling, pain, or discharge
• Report any issues with blood flow or catheter discomfort immediately

Conclusion

The Tunneled Catheter (Permcath) is a reliable and safe option for patients who require long-term dialysis access. While it comes with some risks, proper insertion, maintenance, and care can ensure its effectiveness. Always consult with a certified nephrologist or vascular specialist for guidance tailored to your health needs.