• In the emergent setting, a venous cutdown
procedure is potentially lifesaving; however, it is considered a
last resort procedure and should only be performed by a clinician
familiar with the technique.
• With the development of modern vascular devices, a traditional
vascular cutdown is less commonly used.
• Antiseptic solution.
• Sedative or analgesic.
• Surgical protective wear (sterile gloves, mask, hat, sterile gown).
• 4–6 sterile towels.
• 10-mL syringe, 20–25-gauge needle, 0.5% lidocaine.
• 2 scalpels (#10 and #11 blades).
• 4 × 4 gauze sponges.
• 1 curved hemostat.
• 1 forceps.
• Single-toothed spring retractors (optional).
• Sutures, 4-0 silk ties (1 package), 4-0 nylon suture with cutting
needle (1 package).
• Needle holder.
• 2 cutdown catheters (depends on size of child and vein; can use
between a #14 and #22 gauge).
• Sterile dressing.
• Topical antibiotic ointment.
• Arterial or nerve injury.
• Air embolus, catheter migration or erosion, and arrhythmias (more
often seen with central venous access cutdowns).
• Apply eutectic mixture of local anesthetic (EMLA)
over intended incision site 30 minutes prior to procedure, and administer
morphine or diazepam for sedation.
• Prepare a large area of skin over the intended dissection site
with antiseptic solution and drape the area with sterile towels.
|• The most common sites for possible venous
cutdown include greater saphenous, cephalic, basilic, and jugular
(in neonates) veins.|
• The knee should be abducted and the ankle turned
laterally to achieve adequate exposure of the medial ankle and calf
for the procedure.
• A small transverse skin incision should be made slightly anterior
and cephalad to the medial malleolus perpendicular to the vein.
• With fine dissection, the greater saphenous vein is found in
the subcutaneous tissue.
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