Why is the operation necessary?
A permcath is a type of catheter used for short-term dialysis treatment in patients with poorly functioning kidneys, and for giving chemotherapy or performing a bone marrow transplant in haematology patients. Permcath insertion involves the placement of a special intravenous line into a blood vessel in your neck or upper chest just under the collarbone.
What is the procedure?
To perform permcath insertion, the main vein in the neck is punctured with a needle using ultrasound guidance. A guidewire is passed through the needle into the main vein leading to the heart, using x-rays to make sure it is in the correct place. The vascular surgeon will then thread the dialysis catheter into the right side of your heart (right atrium) and remove the wire. The other end of the catheter is tunnelled under the skin to an exit point on the chest wall. Tunnelling greatly reduces the risk of infection and allows the catheter to remain in for a longer period of time (1-12 months). Permcath insertion will take 15-45 minutes and a dressing will be applied to cover the insertion site after the procedure.
Are there any alternative treatments available?
A non-tunnelled, short, temporary dialysis catheter can be placed in the neck or leg vein. This can only be used for 1-2 weeks and is used if patients are too ill to tolerate a permcath procedure, or the kidneys are expected to recover in that short period.
In the ideal world, dialysis is performed via an arteriovenous fistula or an arteriovenous graft in the arm, without needing a catheter. This requires careful planning and monitoring of kidney function as it takes up to 2-3 months for a vein fistula to be usable and 2 weeks before a graft is ready to be used.
Is the operation safe?
There are risks involved with all procedures, even if they are small. It is, therefore, important to consider the associated risks before you agree to permcath insertion.
General risks associated with permcath insertion are minor and may occur with any surgical procedure. Complications include:
Risk of infection
Deep vein thrombosis
What are the specific risks related to this procedure?
Risks of permcath insertion can be divided into early risks related to the insertion procedure and late risks related to having a long-term catheter in the vein.
A. Early Procedure Related Risks:
Pneumothorax: air outside the lung causing collapse of the lung
Bleeding due to injury to the artery or vein
B. Late Risks
Blockage of the catheter or mechanical malfunction
Thrombosis or clot in the deep vein around the catheter
Narrowing and/or blockage of the main vein leading to the heart
This article was first published at https://topclickblogs.co.za/permcath-insertion-or-tunneled-catheter-insertion/