Venous cutdown: Difference between revisions
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==Indications== | ==Indications== | ||
*As an alternative to venipuncture in critically ill patients in need of vascular access, and in whom venipuncture may be difficult | *As an alternative to venipuncture in critically ill patients in need of vascular access, and in whom venipuncture may be difficult | ||
**Shock | **[[Shock]] | ||
**Asystole or PEA | **[[Asystole]] or [[PEA]] | ||
**Sclerosed veins in IVDA | **Sclerosed veins in IVDA | ||
**Extensive burns or other injuries | **Extensive [[burns]] or other injuries | ||
**Small children | **Small children | ||
| Line 15: | Line 15: | ||
*Bleeding diathesis | *Bleeding diathesis | ||
*Immunocompromise | *Immunocompromise | ||
* | *Extremity injury proximal to the site | ||
==Equipment Needed== | ==Equipment Needed== | ||
| Line 28: | Line 28: | ||
==Procedure== | ==Procedure== | ||
[[File:Venouscutdown2.png|thumb|<ref>Roberts, J. R., Custalow, C. B., & Thomsen, T. W. (2019). Roberts and Hedges' clinical procedures in emergency medicine and acute care (Seventh edition.). Philadelphia, PA: Elsevier.</ref>]] | |||
#Choose site | #Choose site | ||
# | ##Great saphenous vein (most common, usually at the ankle) | ||
# | ##Basilic vein | ||
# | ##Cephalic vein | ||
#Apply tourniquet | #Apply tourniquet | ||
#Clean skin | #Clean skin | ||
| Line 56: | Line 57: | ||
==See Also== | ==See Also== | ||
{{Vascular access types}} | |||
== | ==External Links== | ||
*[https://emcrit.org/emcrit/rapid-saphenous-cutdown-for-trauma/ EMCrit - Rapid Saphenous Vein Cutdown] | |||
===Videos=== | |||
{{#widget:YouTube|id=sYIDyz396Bo}} | |||
==References== | |||
<references/> | |||
Roberts & Hedges 6e, pp 432-439 | Roberts & Hedges 6e, pp 432-439 | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Critical Care]] | |||
Latest revision as of 00:51, 16 July 2021
Indications
- As an alternative to venipuncture in critically ill patients in need of vascular access, and in whom venipuncture may be difficult
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
- Choose site
- Great saphenous vein (most common, usually at the ankle)
- Basilic vein
- Cephalic vein
- Apply tourniquet
- Clean skin
- Make shallow incision perpendicular to vein course
- Bluntly dissect, isolate and mobilize the vein
- Use a hemostat to isolate the vein, and pass silk ties under it, proximal and distal to the proposed cannulation site
- Tie the distal suture only (or just apply traction without tying)
- Incise the vein while retracting the proximal ligature, cutting through 1/3 to 1/2 the diameter of the vein
- Use the venous dilator to lift the flap and then advance the catheter into the vein
- Attach IV tubing to the catheter
- Tie the proximal suture around the vein and catheter
- If distal suture not tied, remove it
- 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
Vascular access types
- Central venous catheterization
- Rapid infusion catheter
- Intraosseous access
- Venous cutdown
- Umbilical vein catheterization
- Ultrasound assisted peripheral line placement
- External jugular vein cannulation
- The "Easy IJ"
- Midlines
External Links
Videos
{{#widget:YouTube|id=sYIDyz396Bo}}
References
- ↑ Roberts, J. R., Custalow, C. B., & Thomsen, T. W. (2019). Roberts and Hedges' clinical procedures in emergency medicine and acute care (Seventh edition.). Philadelphia, PA: Elsevier.
Roberts & Hedges 6e, pp 432-439