b. Venous Cut-down Procedure. Follow this procedure:
(1)
Prepare the skin with povidone and drape the patient.
(2) Infiltrate the skin over the vein with a local anesthetic. A 0.5 percent
solution of lidocaine is recommended.
(3) Make a full-thickness transverse skin incision through the area of
anesthesia. Make the incision two and a half centimeters long.
(4) Identify the saphenous vein. Using a curved hemostat, free this vein
from the spenous nerve by blunt dissection. The saphenous nerve is attached to the
anterior wall of the saphenous vein.
(5) Elevate and dissect the nerve to free the vein from its bed for a distance
of approximately two centimeters.
(6) Tie off the vein distally, using a piece of suture material. Leave the
suture in place for traction.
(7)
Pass a tie about the vein, proximally.
(8) Make a small transverse cut in the vein and gently dilate the opening
with the tip of a closed hemostat.
(9) Introduce a plastic cannula through the opening with the tip of the
catheter towards the heart. Secure the cannula in place by tying the upper ligature
above the vein and cannula. Be sure to insert the cannula an adequate distance to
prevent its coming out.
(10) Attach the IV tubing to the cannula and close the incision with
interrupted sutures.
(11) Apply antibiotic ointment to the puncture site.
(12) Apply a dry, sterile dressing.
c. Possible Complications. There may be some complications from the
venous cut-down and/or the insertion of a cannula. Among possible complications are
the following:
(1)
Cellulitis--a diffuse spreading infection, especially of the subcutaneous
tissues.
(2) Hematoma--a localized mass of blood outside of the blood vessels.
Such blood is usually found in a partly clotted state.
MD0574
3-11
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