Best Permcath Placement In Vascluer Expert

 

Introduction:

• Welcome and introduce the purpose of the presentation.
• Briefly explain what a Permcath is and its importance in vascular access for hemodialysis.

Section 1: Pre-Procedure Preparation

1. Patient Assessment:

   • Review patient history and physical examination.
   • Evaluate venous anatomy using imaging (e.g., ultrasound, venography).
   • Assess for any contraindications (e.g., active infection at the insertion site).

2. Informed Consent:

   • Explain the procedure, risks, benefits, and alternatives to the patient.
   • Obtain written informed consent.

3. Equipment Preparation:

   • Ensure availability of all necessary equipment: sterile gloves, drapes, ultrasound machine, Permcath kit, local anesthetic, sterile gauze, etc.
   • Verify the functionality of ultrasound and other monitoring devices.

Section 2: Procedure Steps

1. Patient Positioning:

   • Position the patient supine with the head turned away from the insertion site.
   • Place a rolled towel or similar support under the shoulders to enhance vein visibility.

2. Site Selection:

   • Preferred sites: Internal jugular vein (IJV), subclavian vein, or femoral vein (in emergency situations or if other sites are not feasible).
   • Use ultrasound guidance to confirm vein patency and location.

3. Aseptic Technique:

   • Perform hand hygiene and wear sterile gloves and gown.
   • Prep the insertion site with an antiseptic solution and apply sterile drapes.

4. Local Anesthesia:

   • Infiltrate local anesthetic at the insertion site to ensure patient comfort.

5. Vein Puncture and Catheter Insertion:

   • Use ultrasound guidance to puncture the vein with a needle.
   • Confirm venous access by aspirating blood.
   • Insert the guidewire through the needle, then remove the needle.
   • Make a small skin incision at the entry site.
   • Advance the dilator over the guidewire to enlarge the tract.
   • Remove the dilator and thread the Permcath over the guidewire.
   • Position the catheter tip in the desired location (usually the right atrium-SVC junction for IJV and subclavian access).
   • Secure the catheter in place with sutures and apply a sterile dressing.

Section 3: Post-Procedure Care

1. Catheter Confirmation:

   • Confirm the position of the catheter tip with fluoroscopy or chest X-ray.
   • Check for immediate complications like bleeding or pneumothorax.

2. Catheter Maintenance:

   • Educate the patient and caregivers on catheter care and infection prevention.
   • Schedule regular follow-up appointments to assess catheter function and site condition.

3. Documentation:

   • Document the procedure details, patient tolerance, and any complications.
   • Record the catheter tip location and post-procedure imaging results.

Conclusion:

• Summarize key points and emphasize the importance of following best practices to minimize complications.
• Encourage questions and provide answers to ensure understanding.

Q&A Session:

• Open the floor for questions from the audience and provide thorough answers.

PERMCATH PLACEMENT

A permcath or tunnelled catheter goes into the main vein to which all veins of our hand orleg enters. These cathters are easy to place, easy to handle, lasts for few months to a year and easy to get dialysis done. But kept for long they can cause severe infection and narrowing and can choke the main vein and thereby stop all options of future AV fistula or graft.

Permcath therefore should be used in patients in whom fitula or graft is not possible or has failed or patient needs immediate dialysis and has no fistula.

WHAT IS DVT?

DVT is deep vein thrombosis. It means clots choke up your major veins of the body which return blood to heart. DVT is most common in leg , pelvic veins and upper limb veins.
In whom are they common?
They are common in people who had recent history of fever or bedridden state. It is very common after major hip, pelvic, lower limb surgeries. Cancer patients are more prone to Deep vein thrombosis. People who are otherwise active but undergo dehydration can have sudden DVT.

HOW DOES DVT PRESENT?

They may present with sudden onset leg swelling with redness and fever. Pain usually accompanies swelling .

HOW IS IT DIFFERENT FROM CELLULITIS?

Cellulitis is skin and soft tissue infection and can be treated by antibiotics. DVT is clot in major veins and needs to be treated by blood thinners.

HOW TO DIAGNOSE A DVT?

Doppler test is the best modality to diagnose DVT

WHAT ARE THE RISKS OF DVT?

Major DVT s can cause life threatening Pulmonary embolism where a major chunk of the clot can break through and reach the lung vessels and choke them and the patient will stop breathing and collapse and may succumb to death immediately.

The clot in the leg can damage the veins permanently leading to black pigmented swollen legs with recurrent ulcers disfiguring the ankle and feet.