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  Saturday, 20 April 2013
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We are handicapped by non-access to an image intensifier/C-ARM/fluoroscopy but would still like to insert permcaths because of the high morbidity with temporary catheters. How does one determine the length of the permcath to be used (i.e. 36 or 40 cm, etc...) and more importantly the insertion length of the permcath? We have access to an ultrasound machine with a vascular probe.
11 years ago

This from one of our staff interventional radiologists:

No right answer on this one. You want the tip of the catheter to lie in the distal SVC or proximal/mid right atrium. However, different companies measure their own catheter lengths differently. Hence, I think you need to identify whatever is the average catheter one would use in the majority of patients, and stick with that one for all but the biggest and smallest patients. You can always adjust the position of the cuff in the tunnel to take individual patient size into account. Without fluoroscopy, I guess you have no options for assessing tip position until the post procedure CXR, unless you can see the tip on cardiac echo.

Dr. Jordan Weinstein
11 years ago
Thanks Dr.Weinstein for the answer. I guess we'll have to wait till we get some form of fluoroscopy before we can attempt the procedure.
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