Five Years Experience with the Quinton Permcath for Vascular Access

Abstract

Over a five-year period 64 Quinton Permcaths were inserted into 51 dialysis patients (age range 17-72 years, mean 52.1 SD 12.83). The duration of catheter use ranged from 5 to 1479 days, mean 315.7 SD 337. The actuarial catheter survival rate at 1 year was 74%, at 2 years 43%, at 3 years 25% and at 4 years 12%. The indications for use were: exhausted peripheral access; CAPD contraindicated; abrupt failure or lack of an arteriovenous fistula; acute renal failure; limited life expectancy; patient insistence; conventional access contraindicated. Only minor complications occurred during insertion: haemorrhage requiring exploration in three patients and a temporary left recurrent laryngeal nerve palsy in one patient. The exit site infection and septicaemia rates were 4.95 and 3.36 per 1000 catheter days respectively. Eighteen catheters failed due to infection (range of use 72-1479 days, mean 559 SD 388). Inadequate initial blood flow (less than 150 ml/min) occurred in 10% of dialyses but only six catheters failed due to intractable flow difficulties (range of use 5-49 days, mean 22 SD 17.5). Catheter sepsis was implicated in the death of two patients. One subclavan/innominate vein thrombosis occurred. The Quinton Permcath represents a significant advance providing immediate, durable, and relatively safe access in a variety of difficult circumstances.

Permanent twin catheter: a vascular access option of choice for haemodialysis in the elderly patients

“…TCath was the first to introduce the concept of bedside percutaneous insertion of silicone polymer catheters [14]. As illustrated by the present series, and in keeping with the concept of a permanent catheter, TCath offered several advantages by comparison with other double-lumen catheters [15]. TCath was easy to insert under local anaesthesia, permitting haemodialysis to be started within 30-45 min [16 ], it permitted the achievement of a high blood flow (300-350 ml/min) with a low recirculation rate on a regular basis, ensuring dialysis dose delivery [17][18][19].…”

Vascular access devices used during harvest of peripheral blood stem cells: high complication rate in patients with a long-term dialysis central venous catheter

“…The majority of reported complications leading to removal of the long-term dCVCs are catheter-related infections (9-28%) 4-7 and failure due to poor flow rates or thromboses (5-30%). 4,[6][7][8][9][10] The published experience on use of long-term dCVC for stem cell harvesting is limited. 3,11,12 In March 1993 we decided to use long-term dCVC for stem cell harvesting and high-dose therapy in patients unable to have peripheral venous cannulae (PVC) due to poor quality of the peripheral veins, with the intention of reducing the number of CVCs inserted in these patients.…”

“…Most experience of long-term dCVCs has been collected in the haemodialysis setting. The majority of reported complications leading to removal of the long-term dCVCs are catheter-related infections (9-28%) [4][5][6][7] and failure due to poor flow rates or thromboses (5-30%). 4,[6][7][8][9][10] The published experience on use of long-term dCVC for stem cell harvesting is limited.…”

Do AshSplit Haemodialysis Catheters Provide Better Flow Rates in the Long Term?

“…[13] Systemic line infection remains the primary catheter limiting factor for both catheters in our study and exceeds the 10% figure quoted by the DOQI guidelines, [3] with no significant difference in rates between the two models. There is controversy among authors as to whether prophylactic antibiotics are necessary on catheter insertion, with some advocating treating patients with tunneled catheters on a par with patients with prosthetic cardiac valves, thus necessitating prophylactic antibiotics for all interventions, [14] while other authors don't give any prophylaxis. [15] Controversy also exists as to the appropriate method of treatment once systemic sepsis is confirmed and the catheter is felt to be infected.…”