Permcath at Patient’s Bedside describes how a patient in a hospital ICU needed abdominal surgery, but his critical condition resulted in the need for a Permcath so he could be discharged and receive six weeks of hemodialysis, and then return stronger and ready for surgery.
Permcath at Patient’s Bedside
– Clinical Case
A patient in a hospital Intensive Care Unit (ICU) needed abdominal surgery, which included hernia repair and the insertion of peritoneal access to receive long-term renal replacement therapy. At the time of admission, the patient needed urgent dialysis, and Vascular Wellness placed a VasCath, also known as an acute/temporary dialysis catheter, at the bedside so the patient could start hemodialysis immediately. The physician care team carefully monitored the patient’s condition and determined that his renal system was not strong enough to proceed with the scheduled surgery. They recommended that a Permcath, also known as a tunneled dialysis catheter, be placed so the patient could be discharged to receive six weeks of hemodialysis in order to improve the probability of the best patient outcome when he returned for the abdominal surgery.
Permcath at Patient’s Bedside
– Diagnosis and Treatment
The physician ordered a Permcath to be placed so the patient could begin the needed therapy immediately, and continue to receive hemodialysis for six weeks after discharge via the Permcath. Fortunately for the patient and the hospital, Vascular Wellness provides expertly placed Permcaths at the patient’s bedside the same day by Vascular Access Board Certified (VA-BC) nurse specialists, enabling patients to begin critical therapies right away and without delay. The Vascular Wellness vascular access expert arrived the same day of the order, and the entire procedure of inserting the Permcath was completed at the bedside within 45 minutes. Outpatient dialysis was able to be arranged immediately due to the speed in which the catheter was placed, and the patient was discharged on schedule.
The dialysis technician was extremely pleased with the high flow rates achieved by the dialysis catheter, which makes dialysis go faster, and the nephrologist was impressed with the speed and efficiency of the Vascular Wellness team. Without Vascular Wellness, the patient would have needed to be transferred to an OR or IR Suite, causing a delay in discharge, an increase in procedure costs, and a decrease in patient satisfaction.
Vascular Access Experts
– Key Points
As Vascular Access Experts, Vascular Wellness pioneered nurse-placed Permcaths. Vascular Wellness’ nurse-placed Permcaths at the bedside have many advantages over the primary alternative of physician-placed devices in an Operating Room (OR) or Interventional Radiology (IR) Suite, including lower costs, faster treatment, and greater facility, physician, and patient satisfaction.
As physician-placed Permcaths are dependent on OR or IR room and medical personnel availability, they are typically not able to be performed the same day due to already scheduled procedures. Transportation within a facility or to another facility to get to the OR or IR room is costly and requires significant coordination of resources. Furthermore, unlike nurse-placed procedures at the bedside where only local sedation is needed, physician-placed Permcaths require patients to fast prior to their Permcath procedure because of the need for anesthesia, which can cause additional delays in treatment. All of these moving parts can cause Delay Cascades for the patient, which are unnecessary delays in receiving critical care therapies that can result in medical complications, increased length of stay, worsening patient condition, waste of clinical resources, and more (see References below).
In addition, Vascular Wellness uses innovative technologies to ensure ideal placement and maximize comfort for the patient. Because Permcaths are long-term tunneled dialysis catheters and utilize a tissue ingrowth cuff, they need to be placed precisely to optimize both function and longevity. Traditionally, fluoroscopy is used to position the wires and final catheter placement. This is a type of X-ray that uses ionizing radiation to visualize the catheter. Vascular Wellness eliminates the cost and risk of this radiation by using ultrasound and tip detection and confirmation technologies that remove the need to expose patients to radiation.
Utilizing Vascular Access Board Certified nurse clinicians from Vascular Wellness to provide expertly placed advanced procedures such as VasCath and Permcath dialysis catheters at the bedside increases patient safety, reduces patient risk, injury, and the chance of infection, decreases costs, and improves overall satisfaction by all stakeholders.
References regarding “Delay Cascade”
- Heart & Lung. Volume 49, Issue3, Page 273-286, May-June 2020
- Journal of Infusion Nursing. 43(4): p222-228, July-August 2020
- Journal of the American College of Emergency Physicians Open. 2020 Dec; 1(6): 1660–1668
Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, South Carolina, and Virginia; and
(2) Customized vascular access services to Tennessee, Georgia, and West Virginia; and
(3) Support vascular access services to Pennsylvania, Ohio, and Kentucky.
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Nurse Clinicians in Action stories highlight some of the interesting cases in which Vascular Wellness clinicians have encountered and participated as valuable team members.
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