Permcath as temporary vascular access for hemodialysis

The efficacy and complications of 30 cuffed, double-lumen silastic catheter s (Permcaths) inserted in 24 patients with chronic end-stage renal failure were studied prospectively at the Security Forces Hospital in Riyadh from J une 1992 until March 1996. The causes of end-stage renal failure in the 24 patients were diabetes mellitus (10), glomerulonephritis (5), hypertension (2), amyloidosis (1), and bilateral small kidneys of unknown cause (6). Loc al anesthesia was used in 27 and general anesthesia in 3 patients. Internal jugular, external jugular, and subclavian veins were used in 13, 12, and 5 instances, respectively. The number of dialysis sessions varied from 1 to 292, with a mean of 59 +/- 60 sessions. The blood flow was 200 to 350 (280 +/- 42) mL/minute. The duration of catheter function varied from 4 to 682 ( 150 +/- 160) days. Six catheters developed poor blood flow due to thrombosi s in one of the two lumens. In two, blood flow improved after use of strept okinase 15000 IU/lumen, and four had to be changed. Four patients developed exit-site infection. Staphylococcus aureus was isolated from three of thes e patients, and all of them improved with systemic antibiotics and local dr essing. Acinetobacter was isolated from one exit site and the catheter was changed because there was no response to antibiotics. Four patients develop ed septicemia; S. aureus was isolated from two, Acinetobacter from one, and one had negative culture. Catheters were removed in two of these patients because there was no response to antibiotic therapy. One patient developed right internal jugular vein thrombosis. The reasons for removal of a Permca th were: poor blood flow (4), death of the patient (3), bleeding and hemato ma (2), renal transplantation (2), septicemia (2), exit-site infection (1), use of arteriovenous fistula (1), patient's request (1), and primary failu re (1). Eleven catheters were functioning until the end of the study. Two p atients were lost for follow-up. In conclusion, Permcath can be used as a temporary as well as a long-term v ascular access. It combines the advantages of being able to be used immedia tely and for an indefinite period that varies from weeks to months.