• ⦿ A permacath is a name for a tunneled hemodialysis catheters — Tunneled dialysis catheters are generally double-lumen catheters with a polyester cuff positioned 1 to 2 cm from the skin exit site usually on the chest. Catheters are generally composed of silicone and other polymers, like thin polyurethane, which are less thrombogenic than the materials used in non-tunneled catheters. These catheters are blunt, soft, and more flexible than non-tunneled catheters often referred to as Quinton catheters or Vascaths.
• ⦿ These tunneled central venous catheter can be left in place for as long as one year and provide permanent access in patients. However despite being considered permanent the longer they are in place the greater the risk that they will eventually become infected. This is why most physicians will try to use these catheters as a bridge for finding other means of even more permanent dialysis such as an arteriovenous fistula or graft which are connections surgically placed between an artery and vein usually starting out on the left forearm to allow for high blood flow and direct puncture with needles to allow for dialysis.

• ⦿ A variety of surface coatings (eg, heparin, silver, chlorhexidine, rifampin, minocycline) have been used to prevent hemodialysis catheter thrombosis and hemodialysis catheter-related infection. While nonhemodialysis catheters with antithrombotic or antimicrobial coatings have demonstrated some efficacy, few studies are available for hemodialysis catheters, and those that are available provide only short-term outcomes.
• ⦿ In early studies, antimicrobial- and antithrombogenic-coated hemodialysis catheters appeared to be effective in preventing intravascular catheter infections in the dialysis setting. However, in a systematic review that evaluated 29 trials with 2886 patients and 3005 hemodialysis catheters, the incidence of catheter-related bacteremia and exit-site infections was similar for antimicrobial-coated hemodialysis catheters compared with noncoated catheters .

• ⦿ The overall survival of tunneled hemodialysis catheters is highly variable. Unassisted one-year use-life (ie, no intervention) of tunneled hemodialysis catheters appears to be as low as 9 percent, but reports are not consistent. Assisted one-year use rates range between 25 and 93 percent. One study reported a 74 percent one-year and a 43 percent two-year catheter survival. A larger study of 623 Tesio catheters (Long term tunneled hemodialysis catheters) reported the one-year and three-year postplacement use-life of 78 and 44 percent, respectively. In another study, assisted one-year patency was 50 percent when the catheter was used as a permanent access. Almost all catheter losses were due to bacteremia.

In general, percutaneous kidney biopsy is a safe procedure. Possible risks include:

• ⦿ Regular hemodialysis to treat kidney failure in an outpatient setting – permacath avoids some of the high infectious risks of non-tunneled hemodialysis catheters and serves as a permanent catheter for dialysis.
• ⦿ Route/access for plasmapheresis.
• ⦿ Frequent blood sampling/infusion in an outpatient setting although other catheters are preferred for this including PICC lines, Portacaths and broviac catheters.
• ⦿ Administration of drugs and fluids during long-term treatment in very specific settings (more commonly used catheters in this setting include PICC lines, Portacaths and broviac catheters)
• ⦿ Administration of caustic medications (chemotherapy) that may harm peripheral veins although the preferred methods of administering these drugs include PICC lines, Portacaths and broviac catheters some centers reportedly use permacaths
• ⦿ A route for TPN and blood products in special cases where smaller bore catheters such as hickman catheters are not able to be used