- Indications
- Emergency venous access when percutaneous routes have failed (e.g. trauma, paediatric resuscitation)
- Used for volume resuscitation, drug delivery, or in surgical procedures requiring central venous access
- Common sites
- Long saphenous vein at the ankle
- Basilic or cephalic vein at the wrist or antecubital fossa
- External jugular vein (less common for cut-down)
- Preparation
- Full aseptic technique
- Local anaesthetic or general anaesthetic depending on urgency and patient status
- Supine position with limb positioned for access
- Steps
- Make a 2–3 cm transverse skin incision over the target vein (e.g. anterior to medial malleolus for saphenous)
- Bluntly dissect through subcutaneous tissue until the vein is identified
- Mobilise and isolate ~2 cm of the veins
- Insert a cannula or central line through the venotomy
- Secure the cannula
- Confirm flashback and flush
- Secure the cannula to the skin and close the wound loosely around it
- Complications
- Bleeding, infection, thrombosis
- Injury to nearby structures (e.g. nerves, arteries)
- Failure to gain access or catheter dislodgement