Venous Access: Saphenous Vein Cutdown



Venous Access: Saphenous Vein Cutdown





The greater saphenous vein is an anatomically constant vein that is easily cannulated for emergency venous access. The saphenous vein at the ankle is constant, although it may be involved by varicose vein disease in elderly patients. Although the interosseus route is faster in children, this remains a useful route of access, especially because it is somewhat removed from the central area and thus out of the way of resuscitative attempts. Bony landmarks render the vein easy to find.

The greater saphenous vein at the groin is sometimes used for introduction of an extremely large catheter, such as a sterile oxygen flow catheter, through which blood and intravenous fluids can be infused rapidly in a patient with traumatic injuries. The techniques of saphenous vein cutdown at the ankle and the groin are described in this chapter. Alternatives are discussed in the references at the end.

SCORE™, the Surgical Council on Resident Education, did not classify saphenous vein cutdown.

STEPS IN PROCEDURE

Cutdown at Ankle



  • Local anesthesia two fingerbreadths above and two fingerbreadths medial to medial malleolus


  • Transverse skin incision


  • Spread tissues in longitudinal direction until vein is seen


  • Elevate the saphenous vein into field


  • Identify and protect saphenous nerve


  • Place ligatures proximally and distally


  • Cannulate vein and tie ligature around cannula


  • Ligate distal vein


  • Secure catheter and close incision

Cutdown at Groin



  • Moderate external rotation


  • Local anesthesia medial to femoral pulse, two fingerbreadths below inguinal crease


  • Incision parallel to inguinal crease


  • Dissect in subcutaneous fat


  • Identify the saphenous vein and elevate into incision


  • Cannulate as described above


  • Use Seldinger technique to avoid ligating vein, if desired

HALLMARK ANATOMIC COMPLICATIONS



  • Injury to saphenous nerve


  • Injury to femoral vein

LIST OF STRUCTURES

Common Femoral Vein



  • Greater saphenous vein


  • Saphenofemoral junction


  • Superficial epigastric vein


  • Superficial circumflex iliac vein


  • Superficial external pudendal vein


  • Medial malleolus


  • Patella


  • Inguinal ligament


  • Superficial fascia

Fascia Lata



  • Saphenous hiatus (fossa ovalis)

Femoral Nerve



  • Saphenous nerve


  • Medial femoral cutaneous nerve


  • Anterior femoral cutaneous nerve







Figure 131.1 Saphenous vein cutdown at the ankle. A: Introduction of catheter into vein without ligation of vein. B: Isolation of vein. C: Insertion of catheter with vascular control of vein. D: Vein ligated distally and catheter tied in proximally.

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Sep 14, 2016 | Posted by in GENERAL SURGERY | Comments Off on Venous Access: Saphenous Vein Cutdown

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