Same Day Tunneled Permcath at the Bedside – Nurse Clinicians in Action – 53

Same Day Tunneled Permcath at the Bedside highlights a case where a patient with several medical conditions had accidentally removed his temporary dialysis catheter and the facility ordered a replacement Permcath, as the patient now needed long-term dialysis.

Same Day Tunneled Permcath at the Bedside

– Clinical Case

A month prior to Vascular Wellness receiving this case, a middle-aged patient was admitted to a hospital with acute hypoxemic respiratory failure, or AHRF, a condition where the tissues do not receive enough oxygen. The patient was intubated and subsequently received a tracheostomy (a procedure that facilitates breathing via an opening that’s created in the windpipe) and a PEG (percutaneous endoscopic gastrostomy or feeding tube) for nutrition.

During this hospital stay, the patient’s pre-existing heart failure worsened and renal failure developed, resulting in the need for dialysis 3 days a week. A month later, the patient was transferred to a nearby LTACH for continued care and rehabilitation. Approximately ten days after arriving at the LTACH, the patient accidentally removed the Vascath, also known as a temporary dialysis catheter, that was placed in the left internal Jugular (IJ) for the dialysis treatments.

The patient’s care team determined that long-term hemodialysis was needed, and they contacted Vascular Wellness to order a Permcath, a large-bore tunneled central line that is placed in the upper chest area for dialysis treatments.

Same Day Tunneled Permcath at the Bedside

– Diagnosis and Treatment

The Vascular Wellness advanced clinicians arrived at the facility a short while later – on the same day as the order – and began a thorough medical history review and physical assessment of the patient prior to beginning the procedure. The clinicians noted numerous serious diagnoses in the patient chart that made this a complex and delicate case.

The patient was suffering from AFib with RVR (Rapid Ventricular Response), DM2 (a genetic disorder characterized by proximal muscle weakness around the shoulders and pelvis), acute kidney injury due to heart failure, respiratory failure, community acquired pneumonia, and class III obesity, among other conditions. To treat these many conditions, the patient was being administered almost a dozen medications, including insulin, vancomycin, sevelamer, eliquis, hydralazine, and many more.

In addition to the many serious medical concerns, the patient’s physical condition presented additional challenges with regard to placement of the Permcath. Because the patient had a tracheostomy, was on a ventilator, and had a feeding tube, the vascular access clinicians needed to take extra care to ensure they maintained a fully sterile field and protected the patient’s airway during the procedure. Additionally, the patient’s rounded body habitus, difficulty following and remembering commands, and significant perspiration created additional challenges and risks that needed to be carefully managed during the procedure.

Despite these many conditions, the Vascular Wellness clinicians had no issues and were able to calmly, quickly, and safely complete the procedure.

The care team was thrilled that despite the patient accidentally removing the Vascath, they were able to have a new tunneled Permcath placed the same day without delay, enabling the hemodialysis to continue on schedule without issue. And since it was tunneled, it was virtually impossible for it to be accidentally removed by the patient.

Same Day Tunneled Permcath at the Bedside | Vascular Access Experts

– Key Points

As Vascular Access Experts, Vascular Wellness pioneered nurse-placed Tunneled Permcaths and has been placing Permcaths and Vascaths at the patient’s bedside for years.  Vascular Wellness developed and continues to ensure best practices with respect to its large bore central line policies, procedures, documentation, and competencies, and such have been lauded during The Joint Commission Surveys and other audits.  It is well established that placement of vascular access devices, including advanced central lines at the bedside is safer, less costly, and enables critical therapies to begin or continue without interruption as compared to the primary alternative of physician-placed devices in an Operating Room (OR) or Interventional Radiology (IR) Suite.  For clarification, there is virtually no comprehensive vascular access nursing team alternative – mobile or in-house, and provider-placed tunneled lines are for all practical purposes, the only alternative.

In addition to lower costs, the placement of Tunneled Permcaths at the patient’s bedside reduces coordination time and effort, enables faster treatment, and greater facility, physician, and patient satisfaction. Because physician-placed Permcaths are dependent on medical personnel availability and an OR or IR suite, they are typically not able to be performed the same day due to already scheduled procedures. And the ability to not take up an OR or IR suite enables providers and facilities to use such suites for other procedures, expanding their impact on patient care.

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. Also, OR and IR suites are generally not available 7 days/week, after-hours, weekends, or holidays, while Vascular Wellness is available every day.

Utilizing Vascular Access Board Certified (VA-BC) nurse clinicians from Vascular Wellness to expertly and timely perform advanced procedures and place vascular access devices such as Acute/Temporary Vascath and Tunneled Permcath dialysis catheters at the bedside increases patient safety, reduces patient risk, injury, and chance of infection, decreases costs, and improves overall satisfaction by all stakeholders, further showing how Vascular Wellness continues in its vision of Advancing Healthcare and Empowering Nurses.

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.

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.