Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter IX: Shock and Resuscitation

Saphenous Vein Cutdown at the Ankle

United States Department of Defense

Saphenous Vein Cutdown at the Ankle

1. One site for a peripheral venous cutdown is the greater saphenous vein at the ankle, just anterior to the medial malleolus. Another secondary site is the antecubital median basilic vein, 2 cm lateral to the medial epicondyle of the humerus at the flexion crease of the elbow. Another site is the proximal greater saphenous vein caudad to the fossa ovalis.

2. Cleanse and prep the skin of the ankle, and drape the area.

3. Infiltrate the skin over the saphenous vein with local anesthetic.

4. A full-thickness transverse skin incision is made through the area of anesthesia to a length of about 2 cm.

5. By blunt dissection, using a curved hemostat, the saphenous vein is identified and dissected free from the saphenous nerve, which is attached to the anterior wall of the vein.

6. Dissect the vein from its bed and elevate the vein for a distance of approximately 2 cm.

7. Ligate the distal mobilized vein leaving the suture in place for traction.

8. Pass a tie about the vein, proximally.

9. Make a small transverse venotomy and gently dilate the venotomy with the tip of a closed hemostat.

10. Introduce a plastic cannula through ithe venotomy and secure it in place with the upper ligature about the vein and cannula. The cannula should be inserted an adequate distance to prevent dislodging.

11. Attach the IV tubing to the cannula and close the incision with interrupted sutures.

12. Apply a sterile dressing with a topical antibiotic ointment. Label the adhesive with the date of the insertion.

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Operational Medicine 2001

Health Care in Military Settings

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