Venous Cutdown

Anatomical considerations

1. Site is the great saphenous at the ankle.  2cm anterior and superior to the medial malleolus.

2. Secondary site is teh antecubital medial basilic vein 2.5cm lateral to medial epicondyle at flexion of elbow crease.

Technique

1. Prepare skin and drape.

2. Local anaesthetic.

3. Full-thickness transverse skin incision through area of anaesthesia to length of 2.5cm.

4. By blunt dissection, using a curved haemostat, identify vein and disect it free from accompanying structures.

5. Elevate and disect veing for 2cm to free it.

6. Ligate distal mobilised vein, leaving suture in place for traction.

7. Pass a tie around the vein, cephalid.

8. Small transverse venotomy, and gently dilate the venotmy with tip of a closed haemostat.

9. Introduce plastic cannula and secure by tying upper ligature around vein and cannula.  Insert a good distance to prevent displacement.

10. Attach tubing and close incision with interrupted sutures.

11. Sterile dress.

Complications

Cellulitis
Haematoma
Phlebitis
Perforation of posterior vein
Venous thrombosis
Nerve transection
Arterial transection