A Permacath is a catheter, a special IV device, that medical professionals insert into a blood vessel, likely in your neck. Permacaths, aka permanent catheters, allow less interrupted access to your bloodstream over an extended period. They can be used for several medical procedures, such as administering medicines and apheresis, which is a technique for separating donated blood components to address illnesses such as leukemia, sickle cell disease, and other ailments. However, permacaths may be a good option for those needing dialysis, the treatment for those with kidney failure.
What Is the Purpose of a Permacath?
It’s likely not convenient to have needles repeatedly inserted and removed when you need medical treatments that require access to your bloodstream multiple times a week. This is why a permacath is useful. As dialysis is often an hours-long procedure occurring several times a week, having a permacath means you wouldn’t necessarily need a new catheter inserted and removed every time you go for treatment.
Cuffed vs. Uncuffed Permacaths
There are two kinds of permacaths: cuffed and uncuffed. Because of the higher risk of infection, a catheter without a cuff is only meant for short-term use. The cuffed catheter is intended to be used long-term and likely permanently. Eventually, your tissue will grow and form around the cuffed permacath to hold it in place and help prevent the growth of infection.
Permacaths vs. Other Types of Catheters
Your medical provider will consider all the options for blood-flood access depending on the type of dialysis you need. For instance, there are three possible access methods for hemodialysis — a procedure where your blood is removed and passed through a dialyzer (artificial kidney), cleaning out the waste products before returning the filtered blood to your body:
- Arteriovenous fistula (AVF): Your medical provider attaches an artery to a vein in your arm.
- Arteriovenous graft (AVG): Your medical provider will use a soft and hollow tube to connect your artery and vein if those blood vessels are not the right lengths for an arteriovenous fistula.
- Dialock vascular access system: This is a port-like device connected to two permanent catheters. Inserting the dialock involves a less invasive procedure than AVF or AVG, with the potential for fewer infections and other complications.
Ideally, the fistula is the first thing to try. Once the fistula matures, it can provide long-term access to dialysis. However, a fistula can take a few months to allow sufficient blood flow for hemodialysis.
There are other circumstances where you cannot have a fistula, aside from your arteries and veins being too short. For example, there isn’t enough time for a fistula to mature if you require emergency dialysis.
A graft is the next option. However, thrombosis is a high-risk issue with grafts.
A permanent placement is the third choice. If you need hemodialysis right away or if one of the other methods doesn't work, a permacath is ideal. This device is ready for use as soon as it’s surgically inserted into your blood vessel.
Where Is a Permacath Placed on the Body?
Your medical provider surgically attaches a permacath to a vein in your neck, but a chest vein may be another choice. Your provider places one opening of the device up to 10 cm under your skin while the other opening exits a different part of your chest.
Prepare for Placement Pre Surgery
You’ll likely have questions if a permacath placement is in your future. Your medical provider can detail the procedure to you and explain all the pros and cons. Most circumstances call for your expressed consent before the surgery, but emergency procedures won’t require your permission pre-surgery.
Your body position for the surgery depends on which vein your provider wishes to access. You could lie flat or lean back in a reclined position. Certain areas of your body will be hooked up to a vital signs monitor.
What To Expect During Surgery
Your healthcare professional will offer you general anesthetic and make sure you're comfortable during permacath placement. If they don't think general anesthesia is a good idea, they can numb the area with lidocaine, and all you should feel is a little pressure as they put the catheter into your neck. Either way, the procedure should only take about 45 minutes.
The catheter will be inserted with a guidewire using ultrasound or fluoroscopy for better placement. A guidewire allows for better placement.
Fluoroscopy is ideal because it uses an X-ray beam in burst shots to take a real-time video of the inside of your body. This makes guiding the permacath into place easier. Your surgeon will insert the catheter's tip into the right atrium of your heart.
What To Know Post Surgery
When surgery is finished, your provider will place a clear dressing over the area to hold it and keep it clean. It’s normal to feel soreness in the permacath area for a few days.
To be sure that surgery was successful, your medical provider will likely perform a chest X-ray to double-check that procedure went according to plan with no complications. Post-surgery recovery is just a few hours, and your permcath is ready for immediate use. Expect to receive at-home care instructions when you’re ready to leave the medical facility.
How Do You Take Care of a Permacath?
After your permacath is in place, you must take proper care of it to avoid the risk of complications and infections. Your provider may advise that you not take a shower or not submerge it in water during the first day.
Slight amounts of blood exiting the insertion site are expected. The bandages on top of your insertion site may fill up with blood once in a while. Remember to change the dressing once it becomes full. You'll want to remove the old dressing and wipe your skin off with water before adding a new cloth. Try not to pull or move the catheter, as you can dislodge it. If that happens, you may have to get a new permacath inserted.
You may be advised not to take off the cap of the permacath. Doing so may let air into the catheter, which can be dangerous. Your provider may advise against using antibiotic creams over the insertion site.
When To Seek Medical Attention
While there is much to remember for your at-home care instructions, there may come a time when you need additional medical attention. Some problem signs and symptoms include:
- Fever, chills, swelling around the insertion site
- Your catheter moves or comes out
- Bleeding for more than 20 minutes
Your healthcare provider or surgeon will likely advise that you immediately contact them if any of these situations happen. If it’s an urgent matter, they may advise you to visit an emergency room.
What Are the Benefits of Having a Permacath?
Benefits of choosing a permacath include:
- Permanent, or at least long-term, access to your bloodstream
- Fewer situations requiring multiple needle insertions
- Reduced pain and discomfort, unlike other IV treatment methods
What Are the Risks of Having a Permacath?
Despite the benefits, a permacath may not always be optimal, and your healthcare provider can help you make that decision. A permacath has a 37% chance of migrating and a 21.7% chance of becoming infected. Therefore, your provider may advise you to look for infection signs, such as redness or swelling.
Additionally, there’s about a 17% risk of developing thrombosis, which is a blood clot. While the risk of infection from a permacath is only about 20%, you could still get a bacterial or a viral infection.
The International Journal of Nephrology reports that methicillin-resistant Staphylococcus aureus (MRSA) is a common bacteria found in catheter-related infections. MRSA is a mutated type of Staphylococcus aureus that is resistant to most antibiotics. It can account for about 26% of catheter related infections.
More research has shown additional bacteria found in catheter-related infections, including S. aureus at 15.9%, other Gram-positive organisms at 50.7%, and Gram-negative organisms at 31.4%.
On the left side of your neck, the left internal jugular has a larger surface area, which makes it more likely that biofilm — tiny microorganisms — will grow, leading to blood clot formation. Biofilms on permacaths give microorganisms a place to grow, and antibiotics may have a hard time killing the bacteria in that area.