Venesection

Venesection

• 1.
  VENESECTION (VENOUS CUT-DOWN) DR.SAJAL TWANABASU INTERN GMCTH
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  INTRODUCTION Venesection is thesurgical emergency procedure in which vein is exposed surgically and then a wide bore cannula is inserted inside the vein under the direct vision. Used to get vascular access in trauma and hypovolemic shock patient when peripheral veins are collapsed and peripheral cannulation is difficult or impossible. A long cannula may be passed down the vein upto the superior venacava and central venous pressure (C.V.P) may be measured
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  If performed properlyperipheral venous cut-down remains a relatively rapid, technically simple and complications free means to obtain and ensure vascular access. Fallen out of favour with the development of safer technique for central venous catheterization as modified seldinger technique, intraosseous infusion. However, venesection remains an excellent alternative when all other approaches have failed.
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  INDICATIONS Absence of peripheralsites for iv cannulation as in obese patient, iv drug users Hypovolaemic shock necessitating rapid large volume fluid resuscitation Venous access in critically ill infants and small children secondary to non visible and non palpable peripheral veins
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  INDICATIONS For prolonged periodof intravenous fluid therapy For parenteral nutrition For measurement of central venous pressure
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  SITES Great saphenous veinat the ankle or at the groin Basilic vein at the arm Cephalic vein at the deltopectrol groove Great saphenous vein at the ankle is the most commonly used site.
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  CONTRAINDICATIONS Coagulopathy or bleedingdiathesis Vein thrombosis Overlying cellulitis Significant vascular or orthopedic injury to the site of cut down Previous operative harvesting of saphenous vein bypass graft in case of saphenous vein cut down Less invasive or technically faster means of central or adequate peripheral access exists.
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  EQUIPMENT Mask, gloves anddrape Sterile prepatory solution Syringe; 5ml with a 25 gauze needle Scalpel No. 10 or No. 11 Curved haemostat Scissor IV catheter ≥ 14 guaze IV tubing Two silk ties 3-0 Prolene suture, 4-0; cutting needle Tourniquet may be used
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  PROCEDURE Patient is placedin a supine position with foot externally rotated Preparing the skin of the ankle with the antiseptic solution like betadine Draping of the area Locating the vein 1cm medial and 1cm superior to medial malleolus Anaesthetizing the skin over the area by infiltrating 1% lidocaine with or without adrenaline through 25 gauze needle
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  Making around 2.5cm full thickness transverse skin incision over the site Bluntly dissecting the subcutaneous tissue parallel to the course of great saphenous vein with curved haemostat Freeing the vein from its bed for the length of 2 cm
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  Passing the tieswith the curved haemostat underneath the exposed veins proximally and distally Ligating distal exposed vein and leaving the free end of the tie in place for traction Applying traction on the proximal tie to further expose the vessel from its bed Performing a small transverse venotomy through no more than 50% of the total diameter of the vessel
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  Introducing plastic catheter(≥14 guaze) through venotomy opening and securing it with the proximal tie Attaching intravenous tubing to the catheter Alternatively, iv tubing can be inserted directly into the venotomy site for more rapid flow rates Applying sterile dressing
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  COMPLICATIONS Failed cannulation Hemorrhage Phlebitis Perforation ofposterior wall of vein Venous thrombosis Air embolism Damage to the saphenous nerve Nerve or arterial transection
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  THANK YOU!!!