Can anyone share their experience with permcath removal at bedside? In the past at my facility permcath removals have always been done in OR, but recently the surgeons have begun removing them at bedside using lidocaine and full sterile precautions. Are there any resources indicating what is best practice? And what type of dressings are being placed afterwards? Any special precautions or considerations for nursing floor staff?
Permacath is a brand name and I am fairly sure it has a subcutaneous cuff. You should be certain of the specific brand being used, then locate the instructions for use for this device, either online or from a device package. See what the manufacturer states about removal. If there is a SC cuff, it must be removed. Many times, this SC dissection is the reason for removal in the OR. Others will just place a lot of traction on the external catheter to pull the cuff out with the catheter. I am not aware of any studies stating one site is better than the other but you should do a literature seach to see what is available. Hemostasis at the point where the catheter enters the vein is required. So you will need to know if this point is subclavian or jugular. Also attention to the area where the SC cuff was located and the skin exit site to assess for inflammation, etc. Educate the patient about all of these sites and what to look for, and to whom any questions or complications should be reported after discahrge. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Yesterday the IR doc removed a Permcath from a hemodialysis patient in the Ambulatory Treatment Center here at my 300 bed hospital. This is the first time we had performed this procedure in my unit. His appointment time was 1030. He had just come off dialysis at a outside center at 0930. I called the dialysis center to see if he had been heparinized during dialysis. He had: a 2000 unit bolus and 1000u/hr x 3 hours, for a total of 5000 units of heparin. In general, the half life on heparin is 60-90 minutes and the IR doc stated he needed at least 2 hours post-heparin infusion to remove the catheter. No labs were drawn. No iv was started. No consent was required. The IR doc did it as a sterile procedure in our procedure room and I assisted. The patient was lying flat on a gurney. The doc numbed the site several times with several cc's of 1% lido with epinephrine. Then he used two sizes of hemostats to release the cuff from the sq tissue, poking deep into the hole. As the doc held pressure at the jugular (the entrance site--under the skin, of course), he slid the catheter out. We also did a tip culture since we were removing it for redness and drainage at the exit site. He held pressure for under a minute, placed some gauze and a big op-site over the exit site, and told the patient not to get it wet and that he could remove it in 24 hours. I gave the patient a few supplies to change the dressing if it had not scabbed off by the next day. The patient was told to stay upright and not lie flat for six hours.