What Is a Venous Cutdown Procedure?

Reviewed on 1/29/2021

Venous cutdown procedure
The physician recommends this procedure when other less-invasive procedures for IV insertion fail.

Venous cutdown is an emergency procedure where a physician surgically exposes the vein and inserts a cannula into the vein under direct vision. It is mostly done in cases of emergency where rapid access is required for intravenous (IV) fluid therapy. A cutdown procedure gives the physician access to the saphenous or antecubital vein. The physician recommends this procedure when other less-invasive procedures for IV insertion fail.

Venous cutdown is indicated in the following conditions: 

  • Difficulty in locating a vein large enough for a needle to pierce unbroken skin
  • Unsuccessful peripheral IV attempts

Furthermore, a cutdown procedure is indicated in

A cutdown procedure should be avoided when you have

In infants and children, venous cutdown has largely been replaced by intraosseous access.

How does a physician perform a cutdown procedure?

Before the procedure, the physician selects two sites for venous cutdown: the primary site and the secondary site.

  • Primary site: The primary site is the greater saphenous vein at the ankle.
  • Secondary site: The secondary site is the antecubital vein or basilic vein, which is a prominent superficial upper arm vein located at the inner side of the elbow.

To perform a cutdown procedure, the physician

  • Prepares the skin for sterilization with Betadine and drapes the area.
  • Injects local anesthesia to the surgery site.
  • Makes a 2.5-cm incision through the area of anesthesia.
  • Identifies the saphenous vein, and with the help of an instrument called a curved hemostat, they release the vein from the adjacent nerve.
  • Elevates and dissects the nerve to free the vein from its bed.
  • Ties the vein using a suture.
  • Cannulate the vein directly as in regular intravenous (IV) procedure.
  • Attaches the IV tube to the cannula and closes the incision site.
  • Applies antibiotic ointment to the incision site and covers with a dry sterile dressing.

What are the complications of a cutdown procedure?

With a cutdown procedure, there may arise complications due to venous cutdown or during the insertion of a cannula. Some of the complications include:

  • Cellulitis
  • Hematoma (localized mass of blood outside the blood vessel)
  • Phlebitis (inflammation of a vein)
  • Venous thrombosis
  • Nerve transections (cut around a nerve)
  • Arterial transaction (cut around an artery)
  • Perforation (piercing) of the back wall of a vein
  • Injury to the surrounding structures
  • Sepsis (a life-threatening complication of an infection)
  • Failed cannulation
  • Air embolism (entry of one or more air bubbles into the vein or artery, causing it to block)

It is important to remove the catheter within 12-24 hours to reduce the incidence of complications.

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References
https://emedicine.medscape.com/article/80393-overview#a4

https://www.ncbi.nlm.nih.gov/books/NBK532880/#:~:text=The%20venous%20cutdown%20technique%20is,intraosseous%20vascular%20access%20have%20failed.

https://brooksidepress.org/surgery/lessons/lesson-3-emergency-surgical-procedures/3-2-venous-cut-down-procedure/

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