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At least 19 recordsLinked to original sources
PubMed1986

Pediatric venous cutdowns: utility in emergency situations.

Venous access in children can be difficult and, in rare cases, impossible to achieve in a timely fashion. The three methods normally utilized to gain access, peripheral and central venipuncture and venous cutdowns, all require different skill levels for use. However, venous cutdowns, the last resort in intravenous line placement, have no performance standards by which to gauge competence. Therefore, a survey was conducted of the members of the American Pediatric Surgical Association to assess the frequency with which the pediatric cutdown is performed, the amount of time needed for the procedure, and the usual anatomic location where it is performed. Three age groups were included: neonate, one month to five years, and six to 16 years. The performance of five physician groups was also surveyed: pediatric surgeon, pediatric resident, pediatrician, surgical resident, and general surgeon. Results showed that, on the average, 56 cutdowns are done per pediatric surgeon per year. They reported that it took them an average of 11 minutes (range, one to 90 minutes) to complete the procedure in the neonate, eight minutes (range, one to 60 minutes) in the one month to five year group, and six minutes (range, one to 30 minutes) for the six to 16 year olds. The cutdown was found to be rarely used by other physician groups. The time required to complete the procedure, even by experts, makes its use as a first choice in an emergency unrealistic for most clinicians. Utilization of the pediatric venous cutdown, in emergency situations, should be done only by those clinicians familiar with the technique, and only while other methods for venous access are being simultaneously attempted.

Adolescent↗
PubMed2006

Peripheral venous cutdown.

Timely establishment of vascular access is a critical component of the care of the acutely ill or injured patient. Peripheral venous cutdown, once a mainstay in the care of the severely traumatized patient, has progressively lost favor since the introduction of the Seldinger technique of central venous line placement. In fact, recent editions of the Advanced Trauma Life Support (ATLS) text refer to saphenous venous cutdown as an optional skill to be taught at the discretion of the instructor. In certain patients, percutaneous vascular access may be impossible to achieve or result in unacceptable time delays. In these situations, the ability to rapidly and proficiently perform peripheral venous cutdown techniques may prove invaluable and potentially lifesaving. This article reviews the anatomy of the most common sites used for peripheral venous cutdown, peripheral venous cutdown techniques, and the complications associated with peripheral venous cutdown.

Catheterization↗
PubMed1983

Teaching venous cutdown techniques with models.

A venous cutdown may be required in emergency situations in order to establish an intravenous line. Subclavian vein catheterization is now widely used, but may result in significant complications and is often inappropriate when a safer distal vein cutdown could be performed. Inanimate models can be used to teach this valuable technique and have the advantage of availability for repeated practice.

Catheterization↗
PubMed1986

Venous cutdown for pacemaker implantation.

Two hundred sixty-eight dual-chamber pacemaker implants using polyurethane leads for atrium and ventricle were analyzed for the vein of entry for both atrial and ventricular leads. The cephalic vein was used for both leads in 61.2%, the external jugular vein for both leads in 8.6%, both veins in 7.8%, and the subclavian vein alone in 16.4%. The total for venous cutdown alone was 77.6%. There were no complications relevant to the vein of approach for the venous cutdown leads, but there was one pneumothorax requiring thoracic intubation for the subclavian puncture route. Venous cutdown is satisfactory for dual-chamber pacing requiring two lead systems.

Arm↗
PubMed1986

Saphenofemoral venous cutdowns in the premature infant.

Thirty-five preterm neonates that had 42 central venous lines placed via saphenofemoral cutdown in the groin are reviewed. The mean gestational age was 29 weeks; mean birth weight 1,320 g. There were no catheter-associated deaths. Minor complications occurred in 50% of patients. Leg swelling (43%), catheter occlusion (12%), and catheter fluid leakage (10%) were the most common. Infections were minor and occurred in 8% of the cases. We believe this study shows the effectiveness and safety of the saphenofemoral cutdown for central venous access in the premature neonate.

Catheterization↗
PubMed1981

Cardiac catheterization in infants through a venous cutdown sheath.

When percutaneous vascular access for cardiac catheterization of small infants fails, necessitating a cutdown approach, we cannulate the isolated vein (usually the great saphenous vein) with a guidewire, dilator, and sheath with subsequent introduction of the catheter through the indwelling sheath. We have used this technique in sixty-one infants without complications and recommend this modified sheath approach because of the following advantages: ease of introduction of the introducer set and catheter, the ability to change catheters quickly, elimination of distal vascular spasm, reduction of vascular trauma induced by catheter manipulation, prevention of backflow bleeding at the catheter entry site, and possible reduction of catheterization time.

Cardiac Catheterization↗
PubMed1990

A modified wire-guided technique for venous cutdown access.

The use of a guidewire to facilitate the placement of an IV cannula through a cutdown is described. This technique was taught to 24 novice operators (medical students and first-year residents). In a randomized, prospective, crossover study, their performance of this technique in an animal model was compared with the use of the classic cutdown technique. The modified technique was performed 22% (two minutes, 13 seconds) more rapidly, on average, than the classic technique (P less than .05). Other potential advantages of this technique are discussed.

Animals↗
PubMed1993

Recombinant tissue plasminogen activator for neonatal and pediatric vascular thrombolytic therapy.

Thrombotic vascular occlusion may complicate the clinical course of many neonatal and pediatric pathologic processes. Systemic thrombolytic therapy with heparin, urokinase, or streptokinase may not be appropriate in the critically ill neonate because these agents generate a diffuse coagulopathic state. Direct surgical intervention for repair may be precluded by the small size of the vessels involved. Recombinant tissue plasminogen activator (rTPA) induces only a minimal proteolytic state while inducing thrombolysis within the local environment of the clot. We report our experience with regional rTPA infusion in four critically ill patients with venous and arterial thrombotic disorders. there were two brachial artery occlusive lesions--a neonate with iatrogenic occlusion due to a misplaced intravenous catheter and a 2-year-old child with inadvertent arterial ligation during an attempted venous cutdown. Two venous lesions consisted of a full-term neonate with renal vein/inferior vena caval thrombosis and a 32-week infant with partial superior vena caval thrombosis due to a Broviac catheter. Systemic thrombolytic therapy was contraindicated in these patients because of underlying illnesses. Pretherapy vascular evaluation included Doppler examination and angiography. The rTPA infusion was continued until there was evidence of clot lysis by ultrasound, angiogram, or venogram. Infusion rate of rTPA was adjusted according to fibrinogen levels. All three neonates responded successfully to rTPA therapy. Two neonates required only bolus administration and one responded to combined bolus and continuous infusion therapy after 58 hours. rTPA failed to reverse brachial artery occlusion in the 2-year-old child with purpura fulminans.(ABSTRACT TRUNCATED AT 250 WORDS)

Brachial Artery↗