Venous Cutdown

  • Inability to access peripheral veins, including scalp veins in infants
  • Emergent access as well as long-term venous access
  • Less invasive alternatives are available.
  • Infection over site or injury proximal to cut down site
  • Greater saphenous vein can be accessed:
        ■ At the ankle, 1 cm anterior to the medial maleolus
        ■ At the knee, 1-4 cm below the knee and immediately posterior to the tibia
        ■ Below the femoral triangle, 3-4 cm distal to the inguinal ligament, the saphenous vein is easily isolated from the surrounding fat.
  • Basilic vein is generally cannulated at the antecubital fossa 2 cm above and 1-3 cm lateral to the medial epicondyle on the anterior surface of the upper arm.
  • Cephalic vein can be accessed in the antecubital fossa at the distal flexor crease.
  • External jugular vein is superficially located on the SCM muscle. This is not recommended as a first-line venesection site because potential airway management problems, risk of injury to the greater auricular nerve, cervical spine immobilization frequently prohibits access to the area, and it is potentially a hazardous procedure in the uncooperative patient.
  • Tourniquet placed proximal to cutdown site. A skin incision is made perpendicular to vein s course and vein is exposed with blunt dissection. A tie is placed distally. Vein is then incised until lumen is entered. Over-theneedle catheter is placed through incision. Ties are removed, incision is closed and catheter is sutured in place and dressed.
  • Local hematoma, infection, embolization, wound dehiscence, and injury to adjacent structures
  • Vein has been successfully entered when a flashback of dark, free flowing venous blood is seen.