Saphenous Vein Cutdown Emergency Venous Access Gwen Hollaar

Saphenous Vein Cutdown: Emergency Venous Access Gwen Hollaar University of Calgary

Saphenous Vein Cut-Down • Saphenous vein cut down is a quick method of obtaining good venous access for rapid resuscitation in an adult • Saphenous vein is consistent in its location in 99. 3% of cadavers • You can access the saphenous vein in the: – Mid-thigh – Ankle

Saphenous Vein Cut-Down • • • Equipment needed: Scalpel Silk ties x 2 Pick-ups and a curved clamp Intravenous line (angiocatheter or equivalent)

Mid-thigh Saphenous Vein Cut-Down Sartorius muscle Steps: • Externally rotate the upper leg to expose the inner thigh • Landmark the saphenous vein at approximately mid thigh – Remember…the saphenous vein travels superficially over the medial region of the thigh, remaining parallel to the medial edge of the sartorius muscle. It is a superficial structure, so if you go through the superficial fascia of the leg…you’re too deep!

Mid-thigh Saphenous Vein Cut-Down Steps (cont): • Prepare the skin with antiseptic solution and drape the area • Infiltrate the skin over the vein with lidocaine • Make a horizontal incision through the skin • If you do not see the saphenous vein, extend the incision medial and/or lateral • Using blunt dissection with a curved clamp, free the vein from surrounding fatty tissue for a distance of 2 to 3 cm • When you find the vein, place 2 silk ties around it for control

Mid-thigh Saphenous Vein Cut-Down Steps: • Open the vein with a small incision using your scalpel • If you accidentally transect the vein…no problem, place the angiocatheter in the vein and tie off the other end. • Insert the catheter and secure it into place with your proximal silk tie • Tie off the distal side of the vein with your pre-placed tie. • INFUSE! • Close the incision with sutures

Mid-thigh Saphenous Vein Cut-Down • This technique is simpler than gaining venous access at the ankle or groin. • It is the standard approach for high volume venous access at some trauma centres. • It is a very safe technique.

Emergency Venous Access • Venous Access / Cutdowns

Saphenous Vein Cut-Down at Ankle • At the ankle, the saphenous vein travels just ANTERIOR to the medial malleolus. • Make your incision here and follow the same technique • (Although also safe, this approach is more difficult than the mid-thigh approach)