Whenever the blood vessels becomes collapsed and invisible or it becomes difficult to trace a vein and to start an infusion, as in cases of shock and collapse, dehydration, obese patients, young children etc., the veins will have to be exposed, opened and a blunt metal cannula or a piece of fine polythene tubing is inserted into the vein to start an infusion. Such a procedure is known as venesection or cut down.

Venous cutdown may be performed before a major surgery, where a fall in blood pressure is anticipated e.g. in cardiac surgeries.

Indications:

1. When it is impossible to locate a vein large enough to be entered percutaneously by a needle; e.g., when a patient is in shock and collapse and all normally accessible veins are collapsed.


2. Obese patients whose veins are not visible due to adipose tissues.


3. In young patients, in order to approach a large vein.


4. Whenever a large amount of fluids are to be administered rapidly e.g., in cardiac arrest.


5. Before a major surgery, where a fall in blood pressure is anticipated.
To measure central venous pressure.

Procedure:

Under local anaesthesia and with aseptic precautions, the skin is incised and the vein is exposed. The aneurysm needle is passed under it, threaded and drawn back. The loop of thread is cut and two strands are form under the vein, one of which is used to the vein to prevent the escape of blood and the other to tie the cannula in place. The vein is then cut partially between the two ligatures, the cannula is passed and the proximal ligature tied to keep the cannula in place. It is then connected to an I.V. infusion set. The wound is then closed with interrupted sutures.

Preparation of Articles:


Articles and its Purpose:

A covered sterile tray containing

1. B.P. handle with knife 1

      Purpose: to make the incision.

2. Scissors small pointed 1

     Purpose: to make the opening in the vein.

3. Straight rounded tip 1

Purpose: to cut the suture materials etc.

4. Artery forceps 2

Mosquito forceps 2

Purpose: to be used as haemostats.

5. Thumb forceps – toothed.

Purpose: to hold the skin during suturing the wound.

6. Non-toothed 1

Purpose: to hold the dressings etc.

7. Allis forceps 2

Purpose: to hold the tissues in place.

8. Needle holder 1

Purpose: to suture the incision.

9. Needle, cutting, curved 2

Purpose: to suture the incision.

10. Aneurysm needle (right and left)

Purpose: to pass the thread under the vein.

11. Cotton suture No. 40

Purpose: to tie the veins and to suture the incision.

12. Intravenous cannula or fine polythene tubing

Purpose: to introduce the vein.

13.Dressing towels and towel clips or a slit.

Purpose: to create a sterile field.

14. Small bowl.

Purpose: to take the cleaning solutions.

15. Cotton balls, gauze pieces, and cotton pads.

Purpose: to clean the site and to dress the wound.

16. Gloves 1 pair, mask 1 and gown 1 (if available)

Purpose: to maintain the aseptic technique.

17. Syringe (5ml) 1 with needles no 20 and 21

Purpose: to give local anaesthesia.

 

An Unsterile tray containing

1. Lignocaine 1 percent – 1 bottle

       Purpose: to give local anaesthesia.

2. Tourniquet 1

      Purpose:
to distend the vein if necessary.

3. Arm board and bandage

      Purpose: to immobilize the limbs.

4. Adhesive plaster with scissors

     Purpose: to fix the dressing, I.V. tubing etc. in place.

5. Transfer forceps in a sterile container

     Purpose: to handle sterile supplies

6. Kidney tray and paper bag

     Purpose: to receive the wastes.

7. Mackintosh and towel

     Purpose: to protect the garments and the bed.

8. Spot light

     Purpose: to visualize the field.

9. Spirit, iodine etc., in their containers

     Purpose: to clean the area.

10. Articles for I.V. infusions (I.V. solutions, I.V. set, I.V. pole etc)

      Purpose: to start the infusions immediately.

Preparation and After Care of the Patient:

If conscious, the procedure is explained to the patient to win his confidence and the co-operation. He should be reassured. The part (the site of cutdown) is prepared as for any minor surgery. If it is a hairy area, it is shaved and cleaned. The bedding and the garments are protected with a mackintosh and towel. The nurse prepares the articles and assists the doctor in the cutdown. She takes care to follow strict aseptic technique during the entire procedure.

After the infusions have been started, the nurse should see that it is secured carefully by using the armboard, bandages, adhesive plaster etc. The movement of the patient in bed should not dislodge the I.V. cannula. The cut down site is inspected frequently to detect infiltration of fluid and the dislodgement of the cannula etc. the incision site should be cleaned and dressed daily to help in the healing of the wound. After a week, the sutures are removed.

 

AUTHOR: PRIYA YADAV

VENESECTION OR CUT DOWN – NURSING PROCEDURE