How To Place A Tunneled Dialysis Catheter (Permcath)

A common request for an interventional radiologist is placement of catheters, in particular a tunneled dialysis catheter (also known as Perm-A-Cath or Permcath). Here is one approach to placing the catheter via the right internal jugular vein. The approach utilizes an AngioDynamics dual lumen central venous catheter that measures 23 cm tip to cuff (28 cm tip to ports).
  1. Check the patient's height. If between 5 ft (150 cm) and 6 ft (180 cm), in general use a 23 cm tip-to-cuff AngioDynamics tunneled hemodialysis catheter. 
  2. Under ultrasound, visualize the right internal jugular vein, which should be compressible (unless thrombosed). The pulsatile carotid should medial/posterior. 
  3. Anesthetize the skin with 1% lidocaine without epinephrine. 
  4. Advance the 21G micropuncture needle into the jugular vein. 
  5. If there is spontaneous venous return, advance the 0.018 inch microwire to the caba-atrial junction under fluoro.  
  6. If no return but likely in vessel, attach connection tubing and aspirate. Dark blood should flow back easily.
  7. If bright red / pulsatile return, the needle is likely within the carotid artery, so withdraw the needle and hold pressure for 2-5 minutes. 
  8. Once access is gained, make a skin incision along the needle and then blunt dissect using the curved Kelly. 
  9. Exchange the needle for the 5 Fr micropuncture sheath and hub it. 
  10. Remove the inner 3 Fr stylet and the micropuncture wire, holding your finger over the 5Fr lumen. 
  11. Insert 0.035 in J wire and advance into the inferior vena cava. If the wire does not go straight down, consider whether it is in the aorta or in the pleural space. Take care not to irriate the atrium (will cause premature ventricular contractions). If difficult, ask patient take deep breath and hold, then advance. Make sure the J is facing right/posterior (take-off of inferior vena cava from right atrium). 
  12. Once J wire in IVC, ask for catheter. Flush dilators, peel away sheath, and both hubs. 
  13. Lay catheter on patient to judge where to make tunnel. The tip should be near the cava-atrial junction. 
  14. Mark the tunnel entry point on the patient's chest (rule of thumb: 2-3 fingertips below the clavicle). 
  15. Anesthetize the entry point, make an incision, anesthetize the tunnel, then blunt dissect the tunnel. 
  16. Attach the tunneling device and tunnel to the venotomy site in the neck. Pull the catheter all the way through to the hub. It is easier to pull back the catheter later than to advance it.  
  17. Dilate the tract (12 Fr blue, then 14 Fr pink) under fluoro until the tip is at the level of the clavicle, then insert the peel away sheath and hub it. 
  18. Pull out the inner obturator and wire. The valve should maintain hemostasis. 
  19. Insert the catheter as far as possible through the peel away, then remove the valve and break the peel away sheath. 
  20. Peel the sheath away while applying pressure to the catheter to keep it subcutaneous. 
  21. Check positioning - if at caba-atrial junction, fix in place. If too distal, pull back slowly while making sure the cuff stays within the tunnel. 
  22. Flush both ports, give heparin (volume to give on hubs), Dermabond venotomy site, place biostatic pad on tunnel entry site, and then suture to skin with 2-0 silk.
  23. Fold a 4x4 and Tegaderm the port to skin.
Variations on this procedure include measuring using the 0.018 inch wire to get an exact length for the catheter to use and how long to make the tunnel. If the hubs do not flush easily, they may be clotted. Aspirate all the clot out first, then flush. The catheter is ready to use at the end of the procedure, but plans should be in place for the patient to receive an AV fistula by vascular surgery. 

Artikel Terkait

How To Place A Tunneled Dialysis Catheter (Permcath)
4/ 5


Suka dengan artikel di atas? Silakan berlangganan gratis via email

This below all content of radiology information

Neuroradiology Musculoskeletal radiology MRI Musculoskeletal MRI Abnormal Mri Brain X-RAY differential diagnosis Head Neck Anatomy mnemonic CT Teleradiology Radiology News chest Radiology musculoskeletal salary pediatrics ultrasound ultrasound images job Brain tumour abdomen interventional radiology Apk Android CT Abdomen with contrast DAMS Imaging radiology ramblings residency c nature pediatric radiology random ramblings xray C T Radiology Top basics body imaging guide procedure web 2.0 Chest X Ray Interpretation Teleradiology Providers head and neck radiology video Fun Ultrasound Hepatitis b cancer chest radiology salary 1 CXR GenitoUrinary ORTHOPEDICS Sonographic Measurements Stroke dams md/ms coaching mammography radiology business tuberculosis BRAIN Clinicoradiological series FETUS GI radiology Gastrointestinal x ray Radiology 4 Radiology Conferences Radiology Images Telemedicine UPPER LIMPS Ultrasound in Emergencies dynamic MRI lifestyle radiology links renal case spine 3 tesla MRI Dams clinicoradiological series Entrepreneur Gastrointestinal Tract Images Literature Liver abscess ultrasound MD/MS coaching Radiology 40 Radiology Imaging Radiology Journal Radiology PDF Radiology mcqs Ultrasound Technique blog bone tumour cardiac CT career cerebral venous thrombosis chest xray d fracture gadolinium gastrointestinal genitourinary radiology hepatobiliary imaging lipoma medical blogs mri lower abdomen pelvis psychiatry radiation concern social networking technology training urogenital imaging weblog 3D CT Arachnoid cyst CT Cardiac Chest X Ray Diploma Guid Equipment Cost FDA Fibrous dysplasia Interventional Ultrasound Guiding Biopsi MDCT MR Pancreas MRI Vertebrae MRI Vertebrae lumbal MRI contrast MRS RTA Radiology Teaching resource TB Hip TECHNIQUE Tech Thorax X Ray Upper Ext aiims ankle sprain bowel cancer brain abscess case study computers and radiology contrast ependymoma epidermoid facebook guest post internet journal of radiology iphone kienbock disease liver liver segments ct locum tenens mri abdomen multislice CT pericallosal lipoma plain film teaching files private practice radiology humour shoulder arthrogram shoulder dislocation small bowel social media trigeminal neuralgia tuberous sclerosis venous x ray Vertebrae 3d printing 7 tesla MRI ACL reconstruction ACL tear ACLS AIIMS nov 2008 ALPSA lesion ANGIOGRAPHY ATFL B12 deficiency BLS BOLD Breast imaging Breast imaging Mammography CHF CT Paranasal CT Scanner Price CT angiography CT coronary angiography CT technology CV junction CXR teaching files Carcinoid Contrast Agent Creutzfeldt-Jakob Disease Dams MD/ms Dams grand rounds Diffusion weighted imaging Dysmenorrhea E E World Award 2011 EYE Embolization Imaging Entrepreneurship FMG India FMGE FNH Focal liver lesions ultrasound Focal nodular hyperplasia GBM GI Gall bladder Glioblastoma multiforme Glomus jugulare HEAD HEART HRCT HSG Head injury ICA dissection IRIA 2011 IUGR IVC filter Iliotibial Band Friction Syndrome Job Info Kidney Cancer LV thrombus Leptomeningeal cyst MAMOGRAPHY MCI Screening MD MPPG MR mammography MR urography MRA MRCP MRI Cervical MRI update MRI/PET MRV Mesenteric ischemia Middle East respiratory syndrome coronavirus (MERS-CoV) Motor neuron disease NECK Normal Liver US Oncology trial PDF Radiology PM and R Physician PNS Partial anomalous pulmonary venous drainage Persistent trigeminal artery Pg entrance Physiatrist Physiatry Physician Assistant Plastic Surgery Price MRI Machines 2017 Pulmonology Pulvinar sign Radiology Price List Radiology Today Radiology Updates Radiology grandrounds Radiology images of GI Tract Renal Ultrasound Retinal Surgery Rheumatology Ryles tube SKULL Seizure Sellar Masses Sleep Medicine Sports Medicine Subdural hematoma Surgery TBM TRIANGULAR FIBROCARTILAGE COMPLEX Trauma Surgery URI Ultrasound HIV Umbilical vein Update Article Upper Extremity X Ray Urology Usmle VHL Vascular Surgery Veteran Affairs X Ray Head about accessory bone acute cerebillitis acute pancreatitis aiims may 2011 aipg ankle ankle fracture apple articular cartilage aspergilloma atherosclerosis avulsion injury awards bankart lesion basilar artery thrombosis bilateral phaeochromocytoma biopsy bipolar bohler's angle bone tumours brachial plexus brain tb brainstem stroke branchial cyst breast cancer screening buford complex business today calcaneal fracture calcium scoring canned reports carcinoma esophagus carcinoma stomach cardiac ct/pet cardiac pacemaker cardiogen 82 cardiothoracic imaging catrotid artery dissection cavernoma cervical lymphnode levels chest radiographic score chest radiographs choledocolithiasis classification cloud computing cochlear implant colloid cyst communication in radiology compare case concha bullosa congenital brain anomalies congenital heart disease coronary CT coronary artery disease corpus callosum agenesis craniopharyngioma cryptococcal meningitis ct abdomen and pelvis cystic renal disease dams usmle dams visual treat deep brain stimulator dengue dengue hemorrhagic fever developmental dysplasia devices diagnostic imaging dialysis diffusion MR imaging diffusion tensor imaging diffusion tractography digital radiography distal facial neuroma dsa duplication gall bladder echinococcus echocardiography ectopic kidney elearning elevated diaphragm epilepsy esop facial neuroma fibular osteosarcoma functional mri gastrointenstinal tuberculosis germinoma gifts glioma google google plus gun shot injury haemangioblastoma health 2.0 healthcare consultancy hemangiblastoma hemophilia hippocampus hirayama disease hydatid cyst hypercoagulable hypoxic ischemic encephalopathy indian conferences inferior rectus anomaly infrared interior tomography interstitial lung disease intramedullary metastates intramedullary tuberculomas ipad ipad 2 jacoud's arthropathy kernohan's notch knee kohler's disease krukenberg tumour laceration leber's optic atrophy liver transplant lung contusion lymphatics macros marchifava bingami disease mastoiditis maxillary sinus mucocele medial malleolus ossicle medial tibial stress syndrome medical writting medicare medicolegal aspects of teleradiology migraine mortality motor area mri knee mri lumbal msk penang course mucinous cystadenoma multicentric Glioblastoma multiforme mycotic pseudoaneurysm of superficial temporal artery nephrogenic systemic fibrosis nephrology neurosurgery meets nonradiologist oesophagus olecranon spur online medical games open access opercular syndrome opinion orbit os odontoideum os radiale externum osirix osteochondritis osteochondroma osteoid osteoma outsourcing radiology ovarian tumour parameniscal cyst paranasal sinuses parotid vascular mass patellar sleeve avulsion fracture patent ductus arteriosus patent foramen ovale patient information pelvic MRI pericardial fat phaeochromocytoma pharmaceutical writting pineal tumour placenta accreta placenta increta placental insufficiency pneumococcal pneumonia polycystic kidney disease portal Hypertension posterior circulation stroke power point presentation primary complex protected health information pseudobulbar palsy pseudomyxoma peritonei publications pulmonary edema pulmonary embolism pulmonary tuberculosis rabbit ear sign rad radiographic deterioration pattern radiography radiolo radiologist blogs radiology city radiology debate radiology images of spleen radiology intervensional radiology learning radiology search engine radiology spotter radiology spotters radiolopolis raditudes rathke cleft cyst renal imaging renal sinus tumour right sided aortic arch robot round cell tumour sacral agenesis scaphoid fracture schatzki ring scientific content screening search engine secondaries secondary ossification centres silicosis social radiology soft tissue chondroma solitary pulmonary nodule spectroscopy spinal arachnoid cyst spinal cord tumours spinal osteochondroma spine tumour spinoglenoid cyst sternal tuberculosis stress fracture sacrum stroke mri sub-acute combined degeneration subclavian pseudoaneurysm subependymal giant cell astrocytoma sumer sethi swyer-james syndrome syringomyelia tb teaching video teleradiolo teleradiology business models teleradproviders teleultrasound temporal bone fracture tendoachilles testicular tumour tethered cord. MRI tibial stress fracture total knee arthroplasty total shoulder replacment trachea. tracheal diverticulum tracheal stenosis tracheomalacia traumatic lung cyst triceps tear triquetral fracture tubercular abscess tuberculoma tuberculosis elbow ultrasound image of The segments of the liver umblical artery doppler uroradiology vascular malformation vasovist venous angioma ventriculitis video ct scan video mri viral encephalitis vitamin deficiency