Haemodialysis Line (Permcath)

Useful numbers

What is a Permcath?

A Permcath is a type of Central Venous Line that is used for Haemodialysis.

It is a sterile plastic tube that is inserted under general anaesthetic into your child’s chest, just under the collar bone. It is placed into a blood vessel in the neck (most commonly the jugular vein) and the end sits in the right side of the heart (in the right atrium). The line runs under the skin and exits the body on the upper part of the chest.

When the line is first inserted there will be stitches on the external part of the line to help keep the line in place while it heals. The line also has a small cuff of material which is situated under the skin and is not visible. This helps the body form scar tissue that keeps the line in place and helps prevent infection.

Your child should stay off school for 2 weeks after the line is inserted and avoid doing any form of strenuous exercise. It is important to give the line chance to ‘bed in’ under the skin.

The external part of the line has 2 tubes (lumens), to allow blood to be taken out of the body and returned at the same time.

The permcath allows rapid and needle free access to the blood stream and the large lumens allow large volumes of blood to move quickly and safely from your child into the dialysis machine and back.

Each of the lumens has a clamp and cap on it. This ensures that the blood does not leak out and air and bugs that could cause infection do not get in.

Children with these lines can continue to play, wash and go to school but it is vital that the permcath is cared for properly both in hospital and at home. The following information in this leaflet will help you do this.

Dressing the Permcath

The line dressing will be assessed by a dialysis nurse prior to every session and will be dressed at least once a week on the Dialysis Unit and more often if the dressing is soiled, not attached properly or there is concern about the line exit site.

If the dressing becomes loose, try and secure the dressing with extra tape until a member of the dialysis team can change it on your next session. If the dressing has become wet or has fallen off and is beyond repair it will need changing before this. You will be provided with spare dressings from the dialysis nurses and they will teach you how to change this safely.

However, if you feel unsure contact us using the details provided.

Should you need to change the dressing at home:

• 1) Gather equipment - Dressing, Chloraprep, Appeel. (See image A)
• 2) Wash hands for 40-60 seconds and dry thoroughly on a clean towel.
• 3) Open supplies on a clean surface or tray leaving them in the packet.
  (See image B)

• 4) Use Appeel if needed to remove old dressing. (See image C)
• 5) Observe site for any infection i.e. redness/ swelling/ oozing. Observe if the line looks
  to have dropped i.e. the line outside the body looks longer than it previously did or
  the cuff is visible. If any problems are noticed call the dialysis unit after applying a
  new dressing, or the renal ward if this happens out of hours.
• 6) Wash your hands again for 40-60 seconds.
• 7) Clean the area with Chloraprep for 10 seconds. (See image D).
• 8) Allow to air dry.

• 9) Apply a dressing ensuring the line site is covered (See image E).
• 10) Make sure dressing is stuck securely to skin. (See image F).
  Add extra tape if needed.

How can I look after my Permcath?

It is vital to minimise the risk of getting an infection in the line.

By taking good care of your child’s Permcath it will last longer and prevent problems such as infection or displacement.

It is essential that the caps stay on the ends of the line and the clamps remained clamped while the line is not in use. This ensures that blood does not leak out and air and bugs that could cause infection do not get in. It is also advised that the ends of the lines are wrapped in gauze and secured with tape when not being used.

The dressing around the exit site must be kept clean and dry at all times.

After the line has been inserted, you should avoid showering/ bathing until the wound has fully healed. The dialysis nurses will then show you how to apply a waterproof dressing for when you are able to shower. You however need to be aware that even with this dressing in place the line should not be fully submerged in water or placed fully under the shower. This would increase the chance of moisture getting near the line site which can then cause infection. It is advised to use a hand-held shower and direct the spray away from the line.

Wear clean, loose-fitting clothes around your line and take care when getting dressed and undressed.

When the line is inserted, you need to wait 2 weeks before returning to school and undertaking any strenuous exercise. Then we recommend no contact sports and preferably no swimming.

However, discuss this with your dialysis nurses if you want to play one of these sports.

Do not pull or tug on the line.

Do no allow anyone other than a member of your kidney team to use your line unless they are trained to do so.

Ideally, we would prefer you not attend a hospital other than Leeds Children’s Hospital for medical care.

The exception to this is in a life-threatening emergency when you should always call 999 and be taken to your nearest Emergency department.

Returning to School

After your child has had the initial 2 weeks off school to allow the permcath chance to ‘bed in’ we expect your child to attend school on a daily basis, excluding the time spent on the dialysis unit.

The hospital school teachers will also see them for a lesson while they are on dialysis through the week.

We positively encourage your child to stay as active as possible and join in with games and PE, working at a level which is comfortable and fun for them.

It is advisable to wear a vest or a cropped bra under their clothing to keep the line close to the chest and more secure.

The school will be contacted by one of the dialysis nurses to explain the above to them and if needed a nurse will go and visit the school. An emergency pack will be supplied to the school.

How to tell if something is wrong with my Permcath

At every dialysis session the nurses will check the line for signs of infection.

It is important that if there are any signs of infection at home you call the dialysis unit immediately, or the Children’s Renal ward if out of hours.

It is vital to act on any signs of infection immediately. The Permcath provides direct access to the bloodstream, so if any infection enters the line the child can become very sick.

Signs of infection include:

• A temperature of 38˚C and above, chills or shivering.
• Pain, itching or swelling of the skin around the line exit site.
• Blood or pus under the dressing around the line exit site.
• Stiffness or lack of movement of the neck, shoulder or arm on the side that the line has been positioned (although expect some stiffness in the week after the line has been inserted).

We must presume with any of these symptoms that your child has a line infection until proven otherwise.

We will ask you to bring your child to hospital to be checked. We will take bloods and swabs from the line and start antibiotics. We will then keep your child in hospital to treat and closely monitor until the results come back.

Infections can usually be treated with antibiotics, however if these are severe the line might need to be removed and a new line inserted.

Temperature Guide

The following can be used as a guide on the action to be take in the event that your child develops a raised temperature at home.

Normal Body Temperature

• 36.0 – 37.4˚C
• No action needed

Alert

• Temperature 37.5 – 37.9˚C
• Check every ½ hour
• Phone ward for advice
• Do NOT give Paracetamol or Ibuprofen (this will mask a temperature)

Emergency

• Temperature of 38˚C or above
• Phone ward and go into hospital immediately

What to do in an Emergency Situation

You will be provided with an Emergency Pack to carry around with you at all times. This includes a guide of what to do in the following events.

If a cap comes off end of line:

1. Wash hands.
2. Clean the end of the lumen with a Sani-Cloth.
3. Put on a new cap.
4. Phone ward for advice.

If the line is pulled out / there is uncontrollable bleeding from exit site:

1. Wash hands if the medical emergency allows.
2. Apply pressure to the neck at the side the line is placed
   (on entry site).
3. Cover the exit site with gauze.
4. Call 999 and request an ambulance.

If the line is snapped:

1. Wash hands if the medical emergency allows.
2. Apply clamp from emergency kit above the break.
3. Call 999 request an ambulance.

If the dressing is loose or wet:

1. Wash hands.
2. Remove old dressing, clean exit site with Chloraprep and
   apply new dressing.

If the child has a high temperature (above 38˚C):

• Call the Dialysis unit or the Children’s Renal Ward.

In your emergency pack there should be:

• 2x Gauze, 1x Clamp, 1x Dressing, Hyperfix tape, 2x Alcohol wipes, 2x Caps,
  1x Chloraprep.