Difference between quinton and perm cath placement

The machine makes a bleeping noise. Once the sedation has taken effect the permacath is tunnelled underneath the skin into thejugular vein. You will have 2 — 3 stitches at the bottom of your neck and the catheter will comeout of your chest wall.

There will be another stitch around the catheter, where it leaves your chest wall. A transparentdressing will be put on both those areas and the stitches will be removed in 10 days by theRenal Unit or ward staff. What are the risks and consequences associated with this procedure? There is a small risk as with a jugular catheter of puncturing the lung. Therefore, if you experience excessive pain or shortness of breath when you return to the ward, it is important for you to tell the ward staff immediately.

There is also a small risk of bleeding from the permacath site, and it may be necessary for you to have an extra stitch put in to stop any more bleeding. As with the jugular catheter, there is a risk of infection. In order to minimise this risk, staff wear gloves and use sterile supplies when connecting and disconnecting you to and from the dialysis machine. Your temperature will be checked each time you come to dialyse and the dressing will be checked for any signs of infection underneath it.

It is also important that you inform the Renal Unit staff of any pain, redness or leakage that you may see from the site of the catheter. The dressing is changed at least once a week. If you are concerned about these risks or have any further queries, please speak to your consultant. What are the alternatives? Your consultant has recommended this procedure as being the best option. There are no alternative procedures available.

However, there is always the option of not receiving any treatment at all. Right internal jugular catheters survive significantly longer than left internal jugular catheters, which in turn survive longer than femoral catheters median survival , and days, respectively.

Indeed, these survival figures are an improvement on the 59 day median survival of femoral TVCs reported by Maya and Allon [ 29 ]. Repeated bending of the catheter body and propensity of the exit site to become colonized with bacteria, a consequence of their anatomical site, presumably predispose to thrombosis and infection. On Cox proportional hazards modelling, TVC position proved to be the most influential factor determining survival. There has been a paucity of data regarding survival of different catheter designs.

Richard et al. Trerotola et al. We compared the performance of four types of commercially available tunnelled catheter. Two catheter designs—the HemoSplit and the Tesio twin catheter performed significantly better than the Split-Cath III and Permcath median survival , , and days, respectively. There was no significant difference between the Hemosplit and Tesio survival. Using Cox Proportional Hazard modelling, the design of the TVC was confirmed as an independent predictor of line survival, and the Hemosplit and Tesio designs again demonstrated best survival.

In patients with their first right internal jugular catheter, the differences in survival disappear, all catheters performing relatively well. The differences in performance become apparent again when assessing survival of second and subsequent right internal jugular catheters.

In this subgroup, all catheters significantly outperformed the Permcath; the Hemosplit seemingly surviving the best, although this did not reach statistical significance. Similar findings were observed in patients with left internal jugular catheters. In the femoral site, the Tesio catheter performed best, significantly better than the Permcath and Split-Cath but not reaching significance above the Hemosplit.

Perhaps it was the lack of side ports, or of separation of the end catheters, that contributed to the general poor performance of the Permcath. We did not study factors influencing infection rates in our study, which has been covered in several other studies. We also appreciate that a limitation of the study was that it was not randomized. The economics of haemodialysis access are staggering. The cost in the US alone of maintaining vascular access was over 1 billion dollars in [ 31 ].

Given the current difficulties in vascular access provision, there is likely to be a long-lasting reliance on tunnelled dialysis catheters.

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