Regular hemodialysis to treat kidney failure, repeated blood draws or long-term infusions of medication can make it difficult to access the vascular system through the veins. This activity can make the veins and surrounding tissue painful and it can even damage the veins.
To prevent these problems a radiologist may insert an external catheter called a Permacath into the large central veins of the chest or upper arm. A Permacath can provide access to the vascular system for a year, or it can be used as a point of permanent access.
Permacaths allow for a patient who needs kidney dialysis to avoid multiple catheter insertions. It can also be used to administer caustic medication such as chemotherapy that cause injury to veins.
Preparation for the procedure
You may have blood drawn the day before the procedure.
You should not eat or drink 4 hours before the procedure.
Tell your doctor about any medications you are taking, especially blood thinners.
If you have had a Permacath inserted before, tell your doctor. Also mention any infections you may have had in the past, bleeding problems or allergies to medications.
After talking with your doctor you will be asked to sign a patient consent form.
How is it done?
You’ll change into a gown and lie on an imaging table.
You will be given a sedative intravenously.
An antiseptic will be used to clean the area where the Permacath will be inserted.
You will be given an anesthetic injection to relieve and prevent pain.
The radiologist will access the jugular vein and advance a guide wire into the superior vena cava where the catheter enters the skin and where the needle puncture is made. The radiologist is creating a kind of tunnel that the catheter can be threaded through under the skin. A few tiny stitches will be made to hold it in place for a short time.
The Permacath will have a kind of cuff attached that will help secure the catheter. Scar tissue builds up around the cuff which helps keep it in place and prevent infection. No one will be able to see the cuff which is under the skin. The visible portion of the catheter is a single catheter exiting the chest wall with two extensions.
A bandage will be placed over the site.
The procedure will take about 45 minutes.
You will have a chest x-ray or a recorded fluoroscopic image taken afterward to ensure that the Permacath has been properly placed.
What equipment is used?
The radiologist will use very small instruments to put the Permacath in place. The Permacath is larger than most catheters. There may be an X-ray machine used before, during or after treatment.
What are the risks and benefits?
The risks of having a Permacath inserted include:
- There is always the risk of infection when the Permacath is inserted or in the blood at a later time.
- There is the possibility of bleeding from the catheter if it is pulled.
- There is a minimal chance that the needle tip will puncture the lung wall. If you are short of breath or have pain in the chest in the time after your Permacath is fixed in place, call your physician as soon as you can.
- Over time the Permacath can break or be accidentally moved out of place.
- There can be a blockage in the vein where the Permacath is inserted. This can cause swelling in the arm or head and requires immediate medical attention.
The benefits of having a Permacath inserted include:
- You will not have to have an IV placed every time you need medication such as chemotherapy.
- It will allow kidney hemodialysis when there is no other access to your vascular system.
Who interprets results and how will I get them?
The radiologist will review images of the Permacath in place and will talk to you about it after the procedure.
After the procedure
You will need someone to drive you home.
Nursing staff will teach you how to care for your catheter.