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(Barré) #1
INTERPRETATION OFRESULTS
■ The return of pulsatile flow signifies arterial puncture.
■ Dysrhythmias signal irritation of atria or ventricles. Guidewires and
catheters should be pulled back until dysrhythmias stop.
■ Vein has been entered successfully when a flashback of dark venous blood
that flows freely into the syringe is obtained.
■ CXR will show appropriate placement of subclavian and internal jugular
catheterization.

Venous Cutdown

INDICATIONS
■ Inability to access peripheral veins, including scalp veins in infants
■ Emergent access as well as long-term venous access

CONTRAINDICATIONS
■ Less invasive alternatives are available.
■ Infection over site or injury proximal to cutdown site

TECHNIQUE
■ Greater saphenous vein can be accessed:
■ At the ankle, 1 cm anterior to the medial maleolus
■ At the knee, 1–4 cm below the knee and immediately posterior to the tibia
■ Below the femoral triangle, 3–4 cm distal to the inguinal ligament, the
saphenous vein is easily isolated from the surrounding fat.
■ Basilic vein is generally cannulated at the antecubital fossa 2 cm above and 1–3 cm
lateral to the medial epicondyle on the anterior surface of the upper arm.

PROCEDURES AND SKILLS


FIGURE 19.5. Anatomy of thoracic veins.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Tintinalli’s
Emergency Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:126.)

Int. Jugular vein

Ext. Jugular vein

Subclavian vein

Cephalic
vein

Brachial
vein 1st Rib
Basilic
vein

Sternocleidomastoid
muscle
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