What Is a Venous Cutdown Procedure? Benefits & Complications

The physician recommends this procedure when other less-invasive procedures for IV insertion fail.

Venous cutdown is an emergency procedure where a physician surgically exposes the vein and inserts a cannula into the vein under direct vision. It is mostly done in cases of emergency where rapid access is required for intravenous (IV) fluid therapy. A cutdown procedure gives the physician access to the saphenous or antecubital vein. The physician recommends this procedure when other less-invasive procedures for IV insertion fail.

Venous cutdown is indicated in the following conditions: 

• Difficulty in locating a vein large enough for a needle to pierce unbroken skin
• Unsuccessful peripheral IV attempts

Furthermore, a cutdown procedure is indicated in

• Infants, children, and adults in shock due to fluid loss from the body.
• Burned patients.
• People with deformities in whom anatomical landmarks cannot be located.
• Cardiac arrest without a palpable pulse.
• IV drug abusers where all the veins are scarred.
• Femoral-popliteal or femoral-distal bypass (lower leg bypass operations requiring a vein graft).
• Blood vessel operations requiring a vein patch.

A cutdown procedure should be avoided when you have

• Coagulopathy or bleeding diathesis (a condition in which the blood’s ability to clot is impaired).
• Vein thrombosis (blood clot in a vein).
• Overlying cellulitis (a bacterial infection involving the inner layer of the skin).

In infants and children, venous cutdown has largely been replaced by intraosseous access.

How does a physician perform a cutdown procedure?

Before the procedure, the physician selects two sites for venous cutdown: the primary site and the secondary site.

• Primary site: The primary site is the greater saphenous vein at the ankle.
• Secondary site: The secondary site is the antecubital vein or basilic vein, which is a prominent superficial upper arm vein located at the inner side of the elbow.

To perform a cutdown procedure, the physician

• Prepares the skin for sterilization with Betadine and drapes the area.
• Injects local anesthesia to the surgery site.
• Makes a 2.5-cm incision through the area of anesthesia.
• Identifies the saphenous vein, and with the help of an instrument called a curved hemostat, they release the vein from the adjacent nerve.
• Elevates and dissects the nerve to free the vein from its bed.
• Ties the vein using a suture.
• Cannulate the vein directly as in regular intravenous (IV) procedure.
• Attaches the IV tube to the cannula and closes the incision site.
• Applies antibiotic ointment to the incision site and covers with a dry sterile dressing.

What are the complications of a cutdown procedure?

With a cutdown procedure, there may arise complications due to venous cutdown or during the insertion of a cannula. Some of the complications include:

• Cellulitis
• Hematoma (localized mass of blood outside the blood vessel)
• Phlebitis (inflammation of a vein)
• Venous thrombosis
• Nerve transections (cut around a nerve)
• Arterial transaction (cut around an artery)
• Perforation (piercing) of the back wall of a vein
• Injury to the surrounding structures
• Sepsis (a life-threatening complication of an infection)
• Failed cannulation
• Air embolism (entry of one or more air bubbles into the vein or artery, causing it to block)

It is important to remove the catheter within 12-24 hours to reduce the incidence of complications.