PermCath Placement or Removal
A permcath is a long, flexible tube that is inserted into a vein most commonly in the neck (internal jugular vein) and less commonly in the groin (femoral vein).
This type of ventral venous catheter is tunneled under the skin for a few centimeters usually on the chest before it enter the neck vein. This is done when the catheter is going to be in place for long term (ie. greater than two weeks). If the catheter is not being left in long term than a Vascath can be placed which is a nontunneled central venous catheter that directly enters the neck or groin vein without having to be tunneled under the skin.
These tunneled central venous catheter can be left in place for as long as one year and provides permanent access in patients. However despite being considered permanent the longer they are in place the greater the risk that they will eventually become infected. This is why most physicians will try to use these catheters as a bridge for finding other means of even more permanent dialysis such as an arteriovenous fistula or graft.
Permcaths although they appear to be one tube actually have two hollow bores. One part of the tube is responsible for carrying the blood to the dialysis machine and the other one carries it back from the machine to the body.
Permcatheter removal is as important as its insertion and needs a vascular surgeon to take care of it.
Indications of permcath removal are:
Access no longer required, either due to completion of renal treatment or due to the availability of a better alternative
Catheter related infection
Persistent catheter infection
Damaged or inappropriately functioning catheter
Removal of this tunneled dialysis catheter requires local anesthesia induction followed by a small surgical incision to release the catheter cuff if it has been there for more than 3 weeks. For a cuff that has been in the place for less than 3 weeks, simple traction is enough to pull it out.
Line removal should be planned on a no-dialysis day or before dialysis and should be carried out after conducting blood tests and ruling out bleeding disorders or intake of anti-coagulants.
These procedures can be performed outpatient at our surgical center Vein Treatment Access Care.