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Five years experience with the Quinton Permcath for vascular access
1Department of Nephrology, East Birmingham Hospital, UK.
Insights
The Quinton Permcath offers durable and safe vascular access for dialysis patients, particularly those with complex conditions. Survival rates indicate its utility in challenging situations despite some infection risks.
Area of Science:
- Nephrology
- Vascular Surgery
- Medical Devices
Background:
- Dialysis patients often require long-term vascular access.
- Traditional access methods may be unsuitable for certain patient groups.
- The Quinton Permcath is a type of central venous catheter for dialysis.
Purpose of the Study:
- To evaluate the efficacy and safety of the Quinton Permcath for long-term hemodialysis access.
- To assess catheter survival rates and complication profiles in a cohort of dialysis patients.
Main Methods:
- A retrospective analysis of 64 Quinton Permcath insertions in 51 dialysis patients over five years.
- Data collected included patient demographics, indications for use, catheter dwell time, survival rates, and complications.
- Complications analyzed included insertion-related issues, exit site infections, sepsis, thrombosis, and flow problems.
Main Results:
- Actuarial catheter survival rates at 1, 2, 3, and 4 years were 74%, 43%, 25%, and 12%, respectively.
- Common indications included exhausted peripheral access and contraindications to other methods.
- Minor insertion complications occurred; exit site infection and sepsis rates were 4.95 and 3.36 per 1000 catheter days.
- Catheter failure due to infection occurred in 18 cases; flow difficulties in six.
- Catheter sepsis contributed to two patient deaths; one subclavian/innominate vein thrombosis was noted.
Conclusions:
- The Quinton Permcath provides immediate, durable, and relatively safe vascular access for dialysis.
- It is a valuable option for patients facing difficult or contraindicated conventional access methods.
- Careful monitoring is necessary to manage infection and thrombosis risks associated with long-term use.
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.