Permcath(or Permacath): Placement, Cost, Complications

“What is the use of permcath, doctor?” While working with patients starting on dialysis, this is a question I often encounter.

Permcath is used as a medium to gain access to blood vessels (vascular access) for dialysis over a long time period, generally over months . This access is obtained through a major blood vessel like the jugular vein in the neck or the femoral vein in the groin area. For a shorter duration, like a few days, a temporary catheter is used. 

What is permcath for dialysis?

In patients requiring repeated dialysis or those waiting for AV fistula maturation, permcath provides a great option to start dialysis. A permanent catheter is placed in the jugular vein through the chest. This process is called tunneling and is important to ensure that risk of infection reduces.

Furthermore, permacth is cuffed. This means that there is a “cuff” made of dacron towards the outer end of the catheter. This cuff allows skin  tissue to cover the catheter, thus forming a continuous barrier. This barrier keeps the catheter stable and also prevents bacteria from entering the bloodstream.

Permcath may appear to be a single tube but it actually has two bores: one to allow blood to enter the dialysing machine and another one to facilitate blood return into the body.

It is placed in the body through a minor procedure. The procedure takes place under local anesthesia or sedation and the patient can return to normal activities on the same day.

Permcath or Permacath?

 Although commonly used, Permacath is actually a misspelling. The correct name is “Permcath”.  It is actually the brand name for one of the first successful catheters, manufactured by a company called Covidien.

Over time, the brand name became a generic term to refer to all such catheters. 

The correct medical names for “Permcath” are :

  1. Tunneled dialysis catheter : It is introduced via chest and moves in a short  “tunnel” beneath the skin to enter the jugular vein in the neck. 
  2. Cuffed dialysis catheter : A cuff is present towards the outer end to keep the catheter stable and to prevent bacteria from entering the blood.
  3. Permanent catheter : This type of catheter is preferred for use over months (longer time period). Also, once inserted, it stays at the same place, eliminating the need for recurrent insertion and removal, as is the case with a temporary catheter.

Advantages of Permcath

Permanent catheter has many advantages, compared to its temporary counterpart. Some of these are:

  1. Permcath, once placed, is used for a long time. It can be used from weeks to months. 
  2. It is easy to place and remove. It also minimises the use of needles in carrying out dialysis.
  3. Since permcath is tunneled and cuffed, it reduces complications like infections and blockages, especially when compared to a temporary catheter.
  4. Permcath can be immediately put to use after insertion unlike an AV fistula. In an AV fistula, some time is needed after surgery to allow the fistula to mature. During this time, the patient has to rely on catheter use.
  5. Similarly, when patients seek dialysis in emergency conditions, they can’t wait for a graft or a fistula to get ready. Permcath seems to appear as the most relevant choice at such times.
  6. A permcath is usually indicated for long term dialysis as it prevents multiple catheter insertion. This makes the procedure patient friendly.

Permcath complications

Like any catheter, the use of permcath can cause complications in some patients.

  1. Pain and bleeding after insertion are among the most common complications. They can be easily handled by the medical team.
  2. In a few cases, air in the chest cavity (pneumothorax) or blood in the chest cavity (hemothorax) are reported.
  3. Air can also enter the blood vessel (jugular vein) through the catheter opening if precautions are not taken. This can lead to a condition called air embolism, which can be life threatening. Fortunately, this occurs very rarely. 
  4. In rare cases, the catheter can cause fluid collection around the heart. This fluid then exerts a pressure on the heart muscles and results in Cardiac Tamponade.

Permcath vs fistula

As already discussed, a permcath is usually used while patients wait for the AV fistula to mature. But what exactly is an ArterioVenous fistula and how does it work? Let’s discuss it briefly. 

An AV fistula is a surgical connection made between an artery and a vein, commonly in your arm. Once this connection is made, the blood from the artery goes directly into the vein. This causes the vein to become bigger (dilate) with increased blood flow.  This pressure is used to pump blood into the dialyser and then the purified blood is returned to the body. 

As you can appreciate, the use of AV fistula eliminates the need to insert any artificial tube or catheter into the body. A fistula can be successfully used to conduct dialysis for long time periods, years to even decades.

However, this fistula requires some time to mature. Once the surgery is conducted, it takes a few months for the fistula to start functioning. During this time, a permcath serves as an effective way to continue dialysis for the patient. 

So to summarize, a fistula is the access of choice when it comes to long term dialysis. It’s benefits exceed those of the permcath. 

Permcath care by patient

Once a permcath is put in place, the patient is free to get back to daily life. However, certain points need to be kept in mind when it comes to taking care of your catheter. 

  1. The most important precaution is to keep the catheter closed at all times.The caps and the clamps of your catheter should be kept tightly closed when not being used for dialysis. Don’t try to uncap your catheter otherwise air may enter. This air can cause serious circulation problems in your body.
  2. Keep the catheter dressing clean and dry at all times. Normally it is advised to avoid swimming and other such activities. Taking a short shower is always more beneficial than a long bath. Further use of waterproof dressing can be a good way to ensure this. 
  3. Another minor step could be to make sure that your catheter stays in place. 
  4. If the skin around the dressing looks red or abnormal, try to contact your dialysis centre as soon as possible. Any redness, irritation, swelling etc. could indicate an infection and should be immediately taken care of.

How long does permcath last?

Permanent catheter is meant to be used for a few months till a fistula/graft is ready. A graft is another way to access bloodstream for dialysis. In a graft, a soft, artificial tube forms the connection between an artery and a vein. It is inserted through a minor surgery. 

 In others, if the fistula doesn’t mature, the permcath can be used for a much longer time. It can be used until it’s use causes complications for the patient.

How is a permcath removed?

A permanent catheter might be removed for a variety of reasons. It may no longer be needed in case the treatment duration is completed or a better alternative (fistula/graft) is present. In other scenarios, persistent infection or inefficient functioning can be reasons for removal.

The removal of a permcath is a minor surgical procedure. It starts with administration of an anesthesia, after which an incision is made. The catheter is then removed. The procedure takes about 15 minutes generally and the patient is sent home the same day.

Permcath price

The price of a permcath is usually 7-10 times more than a temporary catheter. The insertion is also a minor surgical procedure, thus raising the cost to about 10 times more than its counterpart.

However, it reduces the risk of complications especially infections, which are very common in temporary catheter use. The decreased complications justify the cost. The total cost may be around 50k to 1.5 lakhs, depending upon the center and the patient’s condition.

It is always a good idea to consult your nephrologist and talk about the available options before starting on your dialysis journey. I hope this article helped you in making your choice. All the best!

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