Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • In general, the cutdown procedure is used for the operative placement of an intermediate or long-term central catheter or in an emergency setting when percutaneous access is unachievable. ++Table Graphic Jump Location|Download (.pdf)|Print• 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. +++ Absolute + • Infection on the skin over the area of the intended cutdown.• Percutaneous access that can be safely achieved. +++ Relative + • Bleeding disorder.• Coagulopathy.• Irritation of skin over area of the intended cutdown. + • Antiseptic solution.• Sedative or analgesic.• Surgical protective wear (sterile gloves, mask, hat, sterile gown).• Tourniquet.• 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. + • Bleeding.• Infection.• Thrombosis.• 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. ++Table Graphic Jump Location|Download (.pdf)|Print• The most common sites for possible venous cutdown include greater saphenous, cephalic, basilic, and jugular (in neonates) veins. +++ Greater Saphenous Vein + • This vein is the preferred site in emergency situations due to its anatomic reliability and ease of access.• Runs slightly anterior to the anterior malleolus (Figure 58–1). + • 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. ++Figure 58–1.Graphic Jump LocationView Full Size||Download Slide (.ppt)Greater saphenous vein. +++ Cephalic and Basilic Veins + • Both veins can be used for both central and peripheral access.• The median basilic vein runs transversely ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.