You are in: eMedicine Specialties > Clinical Procedures > Vascular Techniques Cutdown, Saphenous VeinArticle Last Updated: Mar 12, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 14
  Author: Matthew A Silver, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine; Assistant Residency Director, Albert Einstein College of Medicine Jacobi/Montefiore Emergency Medicine Training Program; Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center Matthew A Silver is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Phi Beta Kappa, and Society for Academic Emergency Medicine Coauthor(s): Louis Gelabert, Physician Assistant, Emergency Department, Montefiore Medical Center, Bronx, NY Editors: Andrew K Chang, MD, Department of Emergency Medicine, Albert Einstein College of Medicine, Assistant Professor, Montefiore Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Luis M Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Gil Z Shlamovitz, MD, Emergency Medicine Center, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital Author and Editor Disclosure Synonyms and related keywords: greater saphenous vein, long saphenous vein, venous cutdown, venotomy, venesection, fluid resuscitation, vascular access, fluid administration, emergent vascular access, emergent bedside vascular access, venectomy, short saphenous vein, vein transsection, venous access OVERVIEWSection 2 of 14
  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 Although the venous cutdown has largely been replaced by over-the-wire percutaneous catheters (also known as central lines), it remains an excellent alternative when other approaches have failed.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 intraosseous access as a secondary route of access and is only recommended when all other methods have failed. The greater saphenous vein is the most common vessel used for the venous cutdown. 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 resuscitation, 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. It continues its superficial course and lies on the posteromedial aspect at the level of the knee. 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. (See Anatomy image.)  Anatomy of the greater saphenous vein. The lesser saphenous vein, also known as the short saphenous vein, does not directly anastomose with the greater saphenous vein. It begins at the lateral aspect of the ankle and runs up the posterolateral lower leg to join the popliteal vein in the popliteal fossa. INDICATIONSSection 3 of 14
Emergent venous access, when attempts to gain access by the peripheral or percutaneous routes have failed. CONTRAINDICATIONSSection 4 of 14
ANESTHESIASection 5 of 14
Local anesthesia is used. See Technique for details. EQUIPMENTSection 6 of 14
POSITIONINGSection 7 of 14
TECHNIQUESection 8 of 14
PEARLSSection 9 of 14
COMPLICATIONSSection 10 of 14
FOR MORE INFORMATIONSection 11 of 14
American College of Emergency Physicians FURTHER READINGSection 12 of 14
eMedicine.com, Inc: Vascular Access: Surgical Perspective eMedicine.com, Inc: Intraosseous Access eMedicine.com, Inc: Shock, Hypovolemic Chen H, Sonnenday CJ, Lillemoe KD. Manual of Common Bedside Surgical Procedures. 2nd ed. MULTIMEDIASection 13 of 14
REFERENCESSection 14 of 14
Cutdown, Saphenous Vein excerpt Article Last Updated: Mar 12, 2007 | ||||||||||||
