Presentation made during internship at Gandaki Medical College

1. VENESECTION (VENOUS CUT-DOWN)
DR. SAJAL TWANABASU
INTERN
GMCTH

2. INTRODUCTION
Venesection is the surgical 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

3. If performed properly peripheral 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.

4. INDICATIONS
Absence of peripheral sites 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

5. INDICATIONS
For prolonged period of intravenous fluid therapy
For parenteral nutrition
For measurement of central venous pressure

6. SITES
Great saphenous vein at 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.

7. CONTRAINDICATIONS
Coagulopathy or bleeding diathesis
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.

8. EQUIPMENT
Mask, gloves and drape
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

9. PROCEDURE
Patient is placed in 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

10. Making around 2.5 cm 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

11. Passing the ties with 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

12. 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

13. COMPLICATIONS
Failed cannulation
Hemorrhage
Phlebitis
Perforation of posterior wall of vein
Venous thrombosis
Air embolism
Damage to the saphenous nerve
Nerve or arterial transection

14. THANK YOU!!!