This document discusses venesection, which is a surgical procedure to access veins for intravenous access. It describes indications for the procedure such as hemorrhagic shock or when peripheral veins are not visible. The preferred site is the great saphenous vein at the ankle or groin. Equipment needed and steps of the procedure are outlined. Potential complications include failed cannulation, hemorrhage, and infection. Venous cutdown remains an option when other intravenous access methods have failed.

1. VENESECTION
DR POOJA PANDEY
JR 1ST YEAR MS GEN .SURGERY
MAYO INSTITUTE OF MEDICAL SCIENCES
BARABANKI

2. INTRODUCTION

3. • A surgical emergency procedure in which a wide bore
cannula is placed Inside the vein under direct vision.
• It is an excellent alternative when other approaches to
veins have failed.

4. INDICATIONS
• In case of hemorrhagic shock where veins are collapsed and non
palpable .
• In case of i.v drug abusers and obese patient where peripheral
veins are not visible .
• In critically ill infants and childrens where non palpable and non
visible peripheral veins.

5. SITES
• Great saphenous vein at the ankle or at the groin – is the most
preferred site .
• Basilic vein at the arm.
• Cephalic vein at the deltopectoral groove.

6. IMPORTANCE
• For prolonged period of intravenous fluid therapy
• For parenteral nutrition.
• For central venous pressure measurement.

7. CONTRAINDICATIONS
• Bleeding diasthesis
• Coagulopathy
• Overlying cellulitis
• Orthopaedic Injury or vascular injury at the site of venous cut
down
• Venous thrombosis

8. EQUIPMENTS REQUIRED
• Equipment used in saphenous vein cutdown includes the following:
• Mask and sterile preparatory solution, gown, gloves, drape
• Gauze pads
• Syringe, 5 mL, with a 25-gauge needle
• Scalpel, No. 10 or No. 11 blade
• Curved hemostat
• Scissors
• Intravenous (IV) catheter (≥14 gauge)
• IV tubing
• Two silk ties, 3-0
• Prolene suture, 4-0, on a cutting needle
• Tourniquet (optional)

9. PROCEDURE
• Prepare the skin of the ankle with antiseptic solution (eg,
povidone-iodine ), and drape the area. Locate the vein 1 cm
anterior and 1 cm superior to the medial malleolus.
• Anesthetize the skin over the area of the planned cutdown by
infiltrating 1% lidocaine with or without adrenaline through a 25-
gauge needle.
• Make a 2.5-cm full-thickness transverse skin incision over the site.
With the curved hemostat, bluntly dissect the subcutaneous
tissue parallel to the course of the great saphenous vein (GSV).
Free the vein from its bed for a length of 2 cm.

11. • With the curved hemostat, pass the ties underneath the
exposed vein proximally and distally. Ligate the distal
exposed vein, and leave the free ends of the tie in
place for traction. Place traction on the proximal tie to
further expose the vessel from its bed.
• With the scalpel, perform a small transverse venotomy
through no more than 50% of the total diameter of the
vessel. Be extremely careful not to transect the vein
fully.

12. CATHETER THROUGH THE
VENOTOMY OPENING, AND
SECURE IT WITH THE
PROXIMAL TIE.
ATTACH IV TUBING TO THE
CATHETER. ALTERNATIVELY,
THE IV TUBING CAN BE
INSERTED DIRECTLY INTO THE
VENOTOMY SITE FOR MORE
RAPID FLOW RATES. THE
DISTAL TUBING CAN BE CUT
ON A BEVEL FOR EASIER
INSERTION INTO THE OPENED
VEIN.
CLOSE THE INCISION WITH
SIMPLE INTERRUPTED
SUTURES. APPLY STERILE
DRESSING.

14. COMPLICATIONS
• Failed cannulation
• Creation of a false passageway in the vessel wall
• Hemorrhage
• Air Embolus
• Venous thrombosis
• Infection
• Nerve transection
• Artery transection

15. Although venous cutdown has largely
been replaced by the use of over-the-wire
percutaneous catheters (also known as
central lines), it remains an excellent
alternative when other approaches have
failed.

16. QUESTIONS
• Q1)Why femoral vein is not used for the venous cut down ?
• Q2) Which vein is preferred for the venous cut down and write down the course of great saphenous
vein?
• Q3)What are the most common complication related to venesection ?
• Q4) A patient came in emergency in a state of shock and no peripheral veins are available .what is the
next line of approach to start fluid resuscitation ?

17. MULTIPLE CHOICE QUESTIONS
1) Cut down on the saphenous vein done?
a)At an ankle
b) At knee
c)At thigh near fossa ovalis
d)At medial to lateral malleolus

18. • 2) During a saphenous vein cutdown just above the medial side of
the ankle, the patient starts to complain of numbness and a
tingling sensation. The cause of this is related to injury of which
nerve?
• a) Superficial perineal nerve
• b)Surak nerve
• c)posterior tibial nerve
• d) saphenous nerve
• e)dorsalis paedis

19. REFERENCE
• Gray H. Anatomy of the Human Body: VII. The veins. 3d. The
veins of the lower extremity, abdomen, and pelvis..
• American College of Surgeons. Advanced Trauma Life
Support Student Course Manual. 9th ed.
• Internet websites