Healthcare and Medicine Reference
2-3 cm lateral to medial epicondyle
4 cm inferior and lateral
to pubic tubercle
2 cm anterior and superior to
Figure 12.14 EZ-IO™ insertion.
Figure 12.15 Cutdown sites.
Child : 1-2 cm lateral to the medial epicondyle of the humerus.
Tie off distal suture and transfi x vein with a needle
Make a vertical stab incision down onto the transfi xing
Long saphenous vein (groin)
Adult : 4 cm inferior and lateral to the pubic tubercle.
needle to produce a hole (venotomy) in the anterior vein wall
Insert a cannula or the cut end of a sterile giving set through
Long saphenous vein (ankle)
Adult : 2 cm anterior and superior to the medial malleolus.
Child : 1 cm anterior and superior to the medial malleolus.
venotomy into vein (Figure 12.16f).
Tie off proximal suture around vein and inserted cannula.
Suture and dress wound.
Step-by-step guide: cutdown method (Figure 12.16)
Place a venous tourniquet proximal to intended cutdown site
The risk of complications with venous cutdown is higher than with
peripheral cannulation and intraosseous access (Box 12.3).
Access to the vein may prove diffi cult in obese patients due
to increased amount of adipose tissue. Incisions may need to be
extended in order to gain adequate exposure.
Damage to adjacent nerves and vessels can occur during the
procedure. The saphenous nerve is often damaged during cutdown
attempts at the ankle.
Even with good exposure cannulation of the vein can be diffi -
cult. It is easy to perforate the posterior vein wall when making a
venotomy in a collapsed shutdown peripheral vein. Transfi xing the
Identify cutdown site and inject local anaesthetic along the
intended incision line if the patient is conscious.
Make a transverse incision through skin being careful not to
damage the underlying vein (Figure 12.16a).
Spread the skin and identify the vein lying at right angles to
the line of the incision. Mobilise a 2-cm length of vein by blunt
dissection using curved forceps (Figure 12.16b).
Pull a loop of suture (e.g. 2/0 vicryl) under vein (Figure 12.16c).
Cut the loop to form proximal and distal sutures.