Venous cutdown

Indications

• As an alternative to venipuncture in critically ill patients in need of vascular access, and in whom venipuncture may be difficult
  • Shock
  • Asystole or PEA
  • Sclerosed veins in IVDA
  • Extensive burns or other injuries
  • Small children

Contraindications

Absolute

• When less invasive options for venous access exist
• Major trauma at target site

Relative

• Overlying soft tissue infection
• Bleeding diathesis
• Immunocompromise
• Extremity injury proximal to the site

Equipment Needed

• Scalpel with 11-blade
• Curved hemostat
• Iris scissors
• 0-0 silk sutures
• Plastic venous dilator
• Large bore IV catheter
• IV tubing
• Tape

Procedure

1. Choose site
   1. Great saphenous vein (most common, usually at the ankle)
   2. Basilic vein
   3. Cephalic vein
2. Apply tourniquet
3. Clean skin
4. Make shallow incision perpendicular to vein course
5. Bluntly dissect, isolate and mobilize the vein
6. Use a hemostat to isolate the vein, and pass silk ties under it, proximal and distal to the proposed cannulation site
7. Tie the distal suture only (or just apply traction without tying)
8. Incise the vein while retracting the proximal ligature, cutting through 1/3 to 1/2 the diameter of the vein
9. Use the venous dilator to lift the flap and then advance the catheter into the vein
10. Attach IV tubing to the catheter
11. Tie the proximal suture around the vein and catheter
12. If distal suture not tied, remove it
13. Tape catheter to skin, close incision

Complications

• Transection of the vein
• Transection of the artery
• Bleeding
• Hematoma
• Phlebitis
• Sepsis
• Thrombus formation
• Injury to surrounding structures

See Also

• Access options

References

Roberts & Hedges 6e, pp 432-439

Authors

Charley Randazzo, Ross Donaldson, Neil Young, Steven McGuire