Permacath Placement in Lucknow

A Permacath is a soft, flexible tube with two channels, used to carry blood to the dialysis machine and back. The name is widely used in India for a tunnelled, cuffed haemodialysis catheter. Part of the tube lies under the skin of the upper chest, part lies inside a large vein, and two short ends with caps stay outside the body.

The tip rests where the large vein meets the heart, where the blood flow is high enough for dialysis. A small cuff under the skin helps to hold the tube in place and acts as a barrier to germs. The tunnel also keeps the skin exit away from the point where the tube enters the vein, which lowers the chance of infection compared with a temporary catheter that is not tunnelled.

A Permacath is used when haemodialysis must start or continue and a fistula cannot be used. Your nephrologist makes that decision. These are common situations.

• Dialysis has to begin soon, and a fistula has not been made or has not matured enough to use.
• A fistula or graft has clotted or narrowed and is waiting for repair, as described on the fistuloplasty page.
• The arm veins are too small or blocked to make a fistula.
• Dialysis is needed for a longer spell after sudden kidney injury, or when no other access is possible.

Infection and narrowing of the large veins are more likely with a catheter, so doctors prefer a fistula when one is possible. A Permacath is often a bridge, and sometimes it is the long-term option when nothing else works.

Placement is usually through the right internal jugular vein in the neck. The skin of the neck and chest is cleaned and numbed. Ultrasound shows the vein, so the needle goes in exactly where it should. A guide wire then passes into the vein, and live imaging confirms its position.

A small channel is made under the skin of the chest, and the catheter is drawn through it. It enters the vein at the neck and leaves the skin lower down on the chest. The tip is placed near the heart and checked on X-ray, the tube is flushed and stitched in place, and a dressing covers the exit. The line can often be used soon afterwards, and the dialysis unit confirms when. Whoever carries out the procedure decides on sedation and explains it beforehand.

These habits keep the line working and keep infection away.

• Keep the dressing dry and intact. Do not swim or soak. Ask your dialysis unit how they want you to wash, as many advise a sponge bath with the chest kept dry.
• Let only trained dialysis staff open it. Nobody else should use the line for drips, injections or blood samples, and the caps stay closed and clamped.
• Do not pull or tug it. Keep scissors, pins and sharp objects away from the tube, and wear loose clothing.
• Dressings are changed by the dialysis nurses, with clean technique, on the schedule the unit sets.
• Wash your hands before touching near the site, and look at the site every day.
• If a cap comes off or the tube is cut, clamp the tube, or pinch it shut, between your chest and the damage. Cover the end with clean gauze and go to the nearest hospital at once.
• If it bleeds, press firmly over the exit with clean gauze and ring your dialysis unit. If it slips out, do not push it back. Press on the site and get help.

Infection is the main risk of a Permacath, so learn its signs. The line is a path from the skin into the bloodstream, and germs can travel along it, particularly if the dressing gets wet or dirty. The warning signs are listed below.

Other risks of placement and use include these.

• Bleeding or bruising in the neck or chest.
• A punctured lung, called a pneumothorax, or a punctured nearby artery. Both are uncommon and are watched for after placement.
• An irregular heartbeat while the wire is near the heart, which usually settles when the wire is moved.
• Clots inside the tube, which make dialysis slow, or clot or narrowing in the large veins over time.
• The catheter moving out of position or kinking.
• Rarely, air entering the vein.

A Permacath is placed on the advice of your nephrologist, who knows your dialysis plan. If you have a fever or an infection, placement is usually put off until it is treated. A bleeding problem or blocked neck veins may mean another site, or another type of access, is chosen.

Send the nephrologist's referral, the dialysis plan and recent reports to the team. They go through the papers, and only then does the team confirm whether the Permacath is placed at our centre or elsewhere, and who will do it. The dialysis unit that will use the line is told the plan.

Other routes for dialysis are a fistula or graft, peritoneal dialysis through the abdomen, and a temporary line that is not tunnelled, for short use only. Your nephrologist explains which fit you. The wider list of interventional radiology procedures is on its own page.