■ Cephalic vein can be accessed in the antecubital fossa at the distal flexor
crease.
■ External jugular vein is superficially located on the SCM muscle. This
is not recommended as a first-line venesection site because potential
airway management problems, risk of injury to the greater auricular
nerve, cervical spine immobilization frequently prohibits access to the
area, and it is potentially a hazardous procedure in the uncooperative
patient.
■ Tourniquet placed proximal to cutdown site. A skin incision is made per-
pendicular to vein’s course and vein is exposed with blunt dissection. A tie
is placed distally. Vein is then incised until lumen is entered. Over-the-
needle catheter is placed through incision. Ties are removed, incision is
closed and catheter is sutured in place and dressed (see Figure 19.6).
COMPLICATIONS
■ Local hematoma, infection, embolization, wound dehiscence, and injury
to adjacent structures
INTERPRETATION OFRESULTS
■ Vein has been successfully entered when a flashback of dark, free flowing
venous blood is seen.
Intraosseous Infusion
INDICATIONS
■ Need for emergent, rapid vascular access when venous access is not available,
especially in children, infants, or newborns
PROCEDURES AND SKILLSFIGURE 19.6. Venous cutdown technique.
(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Tintinalli’s
Emergency Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:130.)
A bone with an interruption in
the cortex (ie, fracture, recent
prior intraosseous site, or
placement of intraosseous
needle through the entire
bone) should not be used for
intraosseous infusion.