Overview
Venous Cutdown is a surgical procedure used to establish venous access when percutaneous methods fail. It involves surgical exposure of a vein for direct cannulation.
Venous cutdown is crucial for emergency venous access when peripheral IV access is impossible. It provides reliable access in trauma, shock, and emergency situations.
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Indications
Failed peripheral IV access
Rapid venous access in trauma
Hemodynamic instability
Difficult pediatric access
Difficult venous access
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, sterile technique setup, equipment preparation, and emergency backup. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure, obtain consent, position patient, prepare sterile field.
⚠️ Common Mistakes to Avoid:
- Inadequate consent
- Poor positioning
- Incomplete sterile prep
💡 Pro Tip:
Position patient supine with leg extended.
Step 2: Site Selection
Choose insertion site (saphenous vein at ankle or groin).
⚠️ Common Mistakes to Avoid:
- Wrong site selection
- Poor vein identification
💡 Pro Tip:
Use saphenous vein at ankle for easier access.
Step 3: Local Anesthesia
Infiltrate local anesthetic at incision site.
⚠️ Common Mistakes to Avoid:
- Inadequate anesthesia
- Wrong technique
💡 Pro Tip:
Use adequate local anesthetic for patient comfort.
Step 4: Skin Incision
Make transverse incision over vein.
⚠️ Common Mistakes to Avoid:
- Incision too small
- Wrong location
💡 Pro Tip:
Make incision perpendicular to vein course.
Step 5: Vein Exposure
Dissect to expose vein, mobilize vein.
⚠️ Common Mistakes to Avoid:
- Inadequate exposure
- Vein injury
💡 Pro Tip:
Carefully dissect to avoid vein injury.
Step 6: Vein Cannulation
Cannulate vein, secure catheter.
⚠️ Common Mistakes to Avoid:
- Wrong cannulation
- Catheter dislodgement
💡 Pro Tip:
Secure catheter properly to prevent dislodgement.
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Post-procedure Care
Post-procedure care involves securing the catheter, monitoring for complications, and timely removal when no longer needed.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Bleeding | 5-10% | Excessive bleeding, hematoma | Pressure, exploration if needed | Proper technique, careful dissection |
| Infection | 3-8% | Erythema, purulent discharge | Antibiotics, catheter removal | Sterile technique, proper care |
| Thrombosis | 5-10% | Limb swelling, pain | Anticoagulation, catheter removal | Proper positioning, timely removal |
| Catheter dislodgement | 3-5% | Loss of access, bleeding | Reinsertion if needed | Proper securing |
Clinical Pearls
Use saphenous vein at ankle for easier access.
Make incision perpendicular to vein course.
Carefully dissect to avoid vein injury.
Secure catheter properly to prevent dislodgement.
Use sterile technique throughout the procedure.
Monitor for complications post-procedure.
Remove catheter when no longer needed.