Saphenous Vein Cutdown Technique

Updated: Jun 01, 2017
  • Author: Matthew A Silver, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Technique

Saphenous Vein Cutdown

Prepare the skin of the ankle with antiseptic solution (eg, povidone-iodine or chlorhexidine), and drape the area. Locate the vein 1 cm anterior and 1 cm superior to the medial malleolus.

In pediatric patients, ultrasonography can be a useful aid for localizing the saphenous vein and assessing its size in relation to various standard-size intravenous (IV) catheters that may be considered for use. [5]

Anesthetize the skin over the area of the planned cutdown by infiltrating 1% lidocaine with or without epinephrine through a 25-gauge needle. (See Local Anesthetic Agents, Infiltrative Administration.)

Make a 2.5-cm full-thickness transverse skin incision over the site. With the curved hemostat, bluntly dissect the subcutaneous tissue parallel to the course of the great saphenous vein (GSV). Free the vein from its bed for a length of 2 cm.

With the curved hemostat, pass the ties underneath the exposed vein proximally and distally. Ligate the distal exposed vein, and leave the free ends of the tie in place for traction. Place traction on the proximal tie to further expose the vessel from its bed.

With the scalpel, perform a small transverse venotomy through no more than 50% of the total diameter of the vessel. Be extremely careful not to transect the vein fully. Introduce the plastic catheter through the venotomy opening, and secure it with the proximal tie. The opening of the venotomy site may be difficult to access; if so, try using a 20-gauge needle bent at a right angle as a vein elevator or dilator.

Attach intravenous (IV) tubing to the catheter. Alternatively, the IV tubing can be inserted directly into the venotomy site for more rapid flow rates. The distal tubing can be cut on a bevel for easier insertion into the opened vein.

Close the incision with simple interrupted sutures. Apply sterile dressing.

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Complications

Potential complications of saphenous vein cutdown include the following:

  • Failed cannulation
  • Creation of a false passageway in the vessel wall
  • Hemorrhage
  • Venous thrombosis
  • Infection
  • Nerve transection
  • Artery transection

In a study cited in a 2015 Cochrane review, [15] the risk of insertion failure did not differ significantly between saphenous vein cutdown and intraosseous access, though the former took longer to carry out than the latter. There was no evidfence of a difference between the two techniques for any other outcome.

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