Venous cutdown
Encyclopedia
Venous cutdown is an emergency procedure in which the vein is exposed surgically and then a cannula
is inserted into the vein under direct vision. It is used to get vascular access in trauma
and hypovolemic shock patients when peripheral cannulation is difficult or impossible. The saphenous vein
is most commonly used. This procedure has fallen out of favor with the development of safer techniques for central venous catheterization such as the Seldinger technique and the modified Seldinger technique, as well as the use of ultrasound guidance for placement of central venous catheters without using the cutdown technique.
if time allows. The greater saphenous vein is identified on the surface, a full-thickness transverse skin incision is made, and 2cm of the vein is freed from the surrounding structures. The vessel is tied closed distally, the proximal portion is transected (venotomy) and gently dilated, and a cannula is introduced through the venotomy and secured in place with a more proximal ligature around the vein and cannula. An intravenous line is connected to the cannula to complete the procedure.
, hematoma
, phlebitis
, perforation of the posterior wall of the vein, venous thrombosis
and nerve and arterial transection. This procedure can result in damage to the saphenous nerve
due to its intimate path with the great saphenous vein, resulting in loss of cutaneous sensation in the medial leg. Over the years the venous cutdown procedure has become outdated by the introduction and recent prehospital developments of intraosseous infusion
in trauma/hypovolemic shock patients.
Cannula
A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...
is inserted into the vein under direct vision. It is used to get vascular access in trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
and hypovolemic shock patients when peripheral cannulation is difficult or impossible. The saphenous vein
Saphenous vein
Saphenous vein may refer to:*Great saphenous vein*Small saphenous vein...
is most commonly used. This procedure has fallen out of favor with the development of safer techniques for central venous catheterization such as the Seldinger technique and the modified Seldinger technique, as well as the use of ultrasound guidance for placement of central venous catheters without using the cutdown technique.
Procedure
The skin is cleaned, draped, and anesthetizedAnesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
if time allows. The greater saphenous vein is identified on the surface, a full-thickness transverse skin incision is made, and 2cm of the vein is freed from the surrounding structures. The vessel is tied closed distally, the proximal portion is transected (venotomy) and gently dilated, and a cannula is introduced through the venotomy and secured in place with a more proximal ligature around the vein and cannula. An intravenous line is connected to the cannula to complete the procedure.
Complications
Complications of venous cutdown include cellulitisCellulitis
Cellulitis is a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters,...
, hematoma
Hematoma
A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
, phlebitis
Phlebitis
Phlebitis is an inflammation of a vein, usually in the legs.When phlebitis is associated with the formation of blood clots , usually in the deep veins of the legs, the condition is called thrombophlebitis...
, perforation of the posterior wall of the vein, venous thrombosis
Venous thrombosis
A venous thrombosis is a blood clot that forms within a vein. A venous thrombosis is a blood clot that forms within a vein. A venous thrombosis is a blood clot that forms within a vein. (Thrombosis is a medical term for blood clotting (Haemostasis) occurring in the wrong place, i.e...
and nerve and arterial transection. This procedure can result in damage to the saphenous nerve
Saphenous nerve
The saphenous nerve is the largest cutaneous branch of the femoral nerve.-Path:It approaches the femoral artery where this vessel passes beneath the sartorius, and lies in front of the artery, behind the aponeurotic covering of the adductor canal, as far as the opening in the lower part of the...
due to its intimate path with the great saphenous vein, resulting in loss of cutaneous sensation in the medial leg. Over the years the venous cutdown procedure has become outdated by the introduction and recent prehospital developments of intraosseous infusion
Intraosseous infusion
Intraosseous infusion is the process of injection directly into the marrow of a bone. This technique is used in emergency situations to provide fluids and medication when intravenous access is not available or not feasible.-History:...
in trauma/hypovolemic shock patients.