Healthcare and Medicine Reference
In-Depth Information
Handy hints/troubleshooting
These skills are rarely used and therefore diffi cult to practise. The
fi rst time you perform this procedure may be for 'real'.
Watch videos and practice on mannequins so you are familiar
with the technique and equipment used.
If you are appropriately trained, don't be afraid to use your skills
in an emergency.
(a)
(b)
vein with a needle and cutting down onto the needle will prevent
this in most cases.
Summary
Venous cutdown can be a useful technique when peripheral access
fails and intraosseous access is unavailable. It does carry with it
a greater morbidity, but this may be outweighed by the need for
circulatory access in the unwell patient.
(c)
(d)
Further reading
Bone injection gun™ www.waismed.com
Chappell S,Vilke G, Chan T, Harrigan R, Ufberg J. (2006) Peripheral venous
cutdown. JEM 31(4): 411-16.
EZ-IO™ intraosseous infusion system. www.vidacare.com
FAST1™ intraosseous infusion system. www.pyng.com
Lavis M, Vaghela A, Tozer C. (2000) Adult intraosseous infusion in accident
and emergency departments in the UK. EMJ 17: 29-32.
McIntosh BB, Dulchavsky SA. Peripheral vascular cutdown. (1992) Crit Care
Clin 8: 807-18.
(e)
(f)
Figure 12.16 Cutdown method.
Box 12.3 Complications of venous cutdown
Damage to adjacent structures
Posterior wall perforation
Haematoma
Extravasation of fl uid or drugs
Local cellulites
Phlebitis
Venous thrombosis
Scarring
 
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