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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