A question for dialysis nurses

talaxandra · Oct 31, 2004

Vascaths are for short-term access (72 hours is pushing the recommended maximum time) - ARF, newly-diagnosed renal failure without warning, failure of long-term dialysis access etc. They can be inserted by residents/registrars (at least in my hospital) on the ward, and removed by nurses.

Permacaths are for longer periods, and are occasionally even used as the permanent mode of access (though I have not seen that myself). We usually use them while waiting for a fistula to mature etc. They are inserted in theatre, and removed in theatre (they have an internal Dacron cuff, which encourages tissue permeation, thus reducing the risk of infection).

Unlike other uses for vascaths (long-term drug administration etc), flow rate is vital - you need to be able to pull through a minimum of 250ml/min (200 in a real push) for effective haemodialysis. Because vascath/permacath patency is literally a life-and-death matter, they are locked with high-dose heparin after use, and never used for medication administration or blood collection (the only exception would be in a code, with no other access possible).

Hope this helps :)

jnette, ASN, EMT-I · Oct 31, 2004

Good answer.

I've never seen a vascath yet... and we do have several long term dialysis patients at our facility whose permacaths are "permanent". They have no hope of ever having any other access (graft or fistula).

Real hard to get a decent bloodflow rate with these caths, although one of our patients does achieve a decent 300 BFR most of the time with his. And the possibility of infection is always a real concern with catheters.

Farkinott, RN · Nov 4, 2004

Vascaths are for short-term access (72 hours is pushing the recommended maximum time) - ARF, newly-diagnosed renal failure without warning, failure of long-term dialysis access etc. They can be inserted by residents/registrars (at least in my hospital) on the ward, and removed by nurses.
Permacaths are for longer periods, and are occasionally even used as the permanent mode of access (though I have not seen that myself). We usually use them while waiting for a fistula to mature etc. They are inserted in theatre, and removed in theatre (they have an internal Dacron cuff, which encourages tissue permeation, thus reducing the risk of infection).
Unlike other uses for vascaths (long-term drug administration etc), flow rate is vital - you need to be able to pull through a minimum of 250ml/min (200 in a real push) for effective haemodialysis. Because vascath/permacath patency is literally a life-and-death matter, they are locked with high-dose heparin after use, and never used for medication administration or blood collection (the only exception would be in a code, with no other access possible).
Hope this helps :)

Good post but I would like to clarify one small point. Permacaths are usually inserted as the client has NO onther access so when they are an inpatient the permacath may be used for the administration of medications such as Ab's, albumen and blood.

talaxandra · Nov 5, 2004

Good post but I would like to clarify one small point. Permacaths are usually inserted as the client has NO onther access so when they are an inpatient the permacath may be used for the administration of medications such as Ab's, albumen and blood.

That can certainly be the case for non-renal patients - at my hospital, some patients with long-term diseases and poor access certainly have permacaths inserted for blood products etc.

However, in renal patients these devices are used solely for dialysis. If they lose access they may not be able to be dialysed, and will therefore die.

If you have a renal patient with a vascath/permacath and are unsure about whether or not you can use the access, even if you have an MD telling you you can, contact the renal ward/unit.

kdhnursern · Nov 29, 2004

That can certainly be the case for non-renal patients - at my hospital, some patients with long-term diseases and poor access certainly have permacaths inserted for blood products etc.
However, in renal patients these devices are used solely for dialysis. If they lose access they may not be able to be dialysed, and will therefore die.
If you have a renal patient with a vascath/permacath and are unsure about whether or not you can use the access, even if you have an MD telling you you can, contact the renal ward/unit.

I go with talaxandra on this. The dialysis patient's permacath is a life-line and ONLY used for dialysis except during a code with no other option. And only the dialysis unit should do the heparin packing and dressing changes except in an emergency. Also, the nephrologist is the final word on anything to do with accesses and such.