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Cutdown, Saphenous Vein
eMedicine.com, 2014Introduction Intravenous access is one of the crucial first steps in the resuscitation of any critically ill or injured patient who presents to the emergency department.
When peripheral intravenous access fails, alternative routes must be sought to obtain rapid access for the purpose of infusing intravenous fluids, blood products, or medications.
Although the venous cutdown has largely been replaced by over-the-wire percutaneous catheters (also known as central lines) , it remains an excellent alternative when other approaches have failed.
The technique has been well described in the pediatric literature, where venipuncture may be more difficult secondary to nonvisible or nonpalpable peripheral veins.
In infants and children, however, the cutdown has largely been replaced by as a secondary route of access and is only recommended when all other methods have failed.
Although the procedure can be performed at multiple sites along the length of the saphenous vein, it is commonly performed at the ankle because the predictable and superficial location of the vein in this area allows it to be exposed with minimal dissection.
Moreover, in the midst of , its location distant from the primary resuscitative efforts centered at the head, neck, and torso allow for unhindered accessibility to the site.
Anatomy The greater, or long, saphenous vein, which is the longest vein in the body, originates at the ankle as a continuation of the medial marginal vein of the foot and ends at the femoral vein within the femoral triangle.
At the ankle, it crosses 1 cm anterior to the medial malleolus and continues up the anteromedial aspect of the lower leg.
In the thigh, the greater saphenous vein courses anterolaterally through the fossa ovalis, where it joins the femoral vein approximately 4 cm below the inguinal ligament.
The lesser saphenous vein, also known as the short saphenous vein, does not directly anastomose with the greater saphenous vein.