Perma Cath/Central Venous Catheter (CVC) Procedure in Udupi

Overview

A perma cath is a catheter used as a medium to access the large blood vessels in the body for dialysis. In cancer patients, the perma cath is used for giving chemotherapy to the patients, while in hematology, it is used for performing a bone marrow transplant. The perma cath can also be used to administer medications and parenteral nutrients. It is also useful in the process of plasmapheresis (a process similar to dialysis, used to filter out antibodies from the blood)
The most commonly used blood vessels for inserting the perma cath are the jugular vein in the neck and the femoral vein in the groin. Perma cath insertion is a minor process done under general anesthesia. Once inserted, the catheter stays in place for several weeks and months. Perma cath is a wonderful option for people who require frequent dialysis and those waiting for their AV fistula to mature (an irregular connection made between arteries and veins for dialysis).

What is Perma Cath or Central Venous Catheter (CVC)?

A perma cath is a plastic, tubelike structure used for dialysis and other purposes. The perma cath is placed near the right atrium of your heart via a large vein like the femoral or jugular vein. The procedure is done under general anesthesia, guided by an ultrasound. 
The perma cath is of two types- cuffed and uncuffed. Since the risk of infection is higher with an uncuffed catheter, a cuffed one is preferred for long-term use. The cuffed catheter that protrudes from the chest is about 15 cm long. The perma cath appears as a single tube with two bores. One bore allows the blood to enter the dialysis machine while the other is in place to allow the blood from the machine back into the body.
Along with dialysis for patients with people with damaged kidneys, the perma cath is also used for chemotherapy, plasmapheresis, and performing bone marrow transplants.
These procedures must be performed multiple times a week and are quite painful; hence,a perma catheter inserted in place is well-suited in such cases.

What are the Types of Perma Cath/CVC?

Perma cath is a white-colored, flexible plastic tube with two bores. It is commonly used for dialysis in people with kidney failure. This catheter is of 2 types-

• Cuffed perma cath - In this type, there is a cuff on the tube that rests just below the skin's surface. The body tissues grow around the cuff and hold the perma cath in place. The presence of tissue growth around the cuff prevents infection. This is why a cuffed perma cath is preferred for long-term use.
• Uncuffed perma cath- The uncuffed perma cath, as the name suggests, does not have a cuff. This catheter is preferred for short-term use, as the chances of infection are high.

When Is Perma Cath/CVC Recommended?

Permacath is also known as a permanent dialysis catheter. It is used in a variety of cases. Here are the most common indications-

• Regular hemodialysis in a patient with kidney failure. This process is done as an outpatient procedure. Perma cath acts as a permanent dialysis catheter and avoids the risk of infections.
• It is an access site for plasmapheresis, a procedure similar to dialysis. Plasmapheresis mainly filters out antibodies from the blood.
• Administration of drugs and fluids in long-term treatment in conditions like cancer
• Administration of harmful, caustic medications that may harm the peripheral vein
• A route for administering total parenteral nutrition (TPN) and blood products where small-bore catheters like Hickman catheters cannot be used.

What Are The Pre-procedure Instructions?

A perma cath is generally placed under general anesthesia in a surgical room. The procedure takes about 30 to 45 minutes to complete. Here is how you can prepare for the procedure-

• You can ask your surgeon to explain the details of the procedure along with the necessity of the procedure and the benefits of getting a perma cath inserted. You will be asked to sign an informed consent form agreeing to go ahead with the procedure.
• Discuss your medical history with your surgeon and inform him about-
  • All the medications that you are currently taking for your health conditions
  • Any dietary supplements and herbs that you are taking
  • Allergies towards medicines, if any.
• You will be asked to stop medications like blood thinners (to prevent excessive bleeding during and after the procedure) a week before the procedure.
• On the day of the procedure, you will be asked to fast for a minimum of 4 hours before the procedure.
• You will be asked to arrange for a friend or relative to drive you home after the procedure is completed

How Does The Procedure Work?

Perma cath insertion is a minor process that is done as an outpatient procedure. You can go home the same day once your condition is stable, post-procedure. Here is how the perma cath insertion process works.

• On the day of the procedure, you will be given general anesthesia to numb you to the pain.
• A pulse oximeter will be attached to your finger to keep an eye on the blood oxygen levels during the procedure.
• Once asleep, the jugular vein in your neck is punctured with a needle using ultrasound guidance. Sometimes the femoral vein on the leg is also preferred.
• A guidewire is then inserted into the needle. It is guided all the way to the heart. X-ray or ultrasound is used to ensure it is in the correct place.
• The dialysis catheter is then threaded into the right side of your heart (the right atrium). The wire is now removed.
• The other end of the catheter is tunneled under the skin until an exit point on the chest wall.
• You will have a couple of stitches on the neck where the catheter enters and a suture on the chest wall at the exit point of the catheter.
• Both these areas are dressed with a transparent dressing.
• The sutures stay in place for the next 10 days.
• The entire procedure is completed in under 45 minutes.
• You will be groggy from the effects of anesthesia. Once your vitals, i.e., your temperature, pulse, respiratory rate, and blood pressure, along with the oxygen saturation levels in the blood, are normal, you will be sent home.

What Are The Post-Procedure Instructions?

Once the procedure is complete, you can go home the same day. You can get back to your routine immediately. While being sent home, you will be given a list of instructions to be followed at home.

• Be vigilant at all times, and ensure that the caps and the clamps of the catheter are tightly closed at all times. Air entering your blood circulation through the catheter can lead to an air embolism, a serious and life-threatening event.
• It is normal for you to have a sore, bruised feeling and pain in the neck and chest. If the complaints do not subside within a few days, contact your surgeon immediately.
• The skin around the incision site will look red and bruised after the procedure. This should heal within a couple of days. If the skin is extremely red and feels hot to the touch, it may be a sign of infection. This is an extremely dangerous situation. Seek immediate medical help.
• The dressing on the entry and exit points of the catheter, on your neck and chest, respectively, will be done with water-proof material. However, be careful while bathing. Do not swim or take long showers. Ensure the dressing area is clean and well-dried at all times.
• Do not lift anything heavy with your right arm. This puts pressure on the catheter.
• The catheter can be pulled out easily. Hence you should be careful while rolling in bed and indulging in vigorous activities.
• Healing occurs in 10 to 14 days.

What Are The Potential Complications?

All procedures, however minor, carry a certain risk of complications. Perma cath, too, has potential complications you should be aware of.

• Infection- Infection at the site of insertion and exit of the catheter is a high possibility. Adequate care must be taken during the procedure and at home.
• Pneumothorax (air in the chest cavity) and Hemothorax (blood in the chest cavity) are some complications reported in a few cases.
• If the insertion process is not handled properly, the air is likely to enter the circulation via the jugular vein. This is called air embolism and is a serious, life-threatening event.
• The catheter can sometimes cause fluid to collect around the heart. The pressure from the fluid is exerted on the cardiac muscles, and when the muscles can no longer take the pressure, they simply give up. This condition is known as cardiac tamponade.

What Are The Advantages Of Perma Cath?

A permanent catheter has several benefits over the temporary one.

• Once placed, a perma cath can be used for several weeks and months.
• It minimizes the use of painful needles in dialysis.
• Complications like infections are reduced when a cuffed perma cath is used.
• Once inserted, a perma cath is ready to use immediately. This is unlike an AV fistula, which requires time to mature before it can be used. An AV fistula is a connection between an artery and vein surgically in your arm or leg for dialysis.
• It is the best option for patients seeking immediate dialysis.
• Patients requiring multiple dialyses in a week for a long period find a perm cath immensely useful.

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