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Venous cutdown : ウィキペディア英語版 | Venous cutdown
Venous cutdown is an emergency procedure in which the vein is exposed surgically and then a cannula is inserted into the vein under direct vision. It is used to get vascular access in trauma and hypovolemic shock patients when peripheral cannulation is difficult or impossible. The saphenous vein is most commonly used. This procedure has fallen out of favor with the development of safer techniques for central venous catheterization such as the Seldinger technique, the modified Seldinger technique,〔Seldinger SI: Catheter replacement of the needle in percutaneous arteriography. Acta Radiol 1953; 39:368-376〕〔McGee WT, Mallory DL: Cannulation of the internal and external jugular veins. In: Vascular Cannulation. Problems in Critical Care. Vol. 2. Venus B, Mallory DL (Eds). Philadelphia, PA, JB Lippincott, 1988, pp 217-241〕〔Brahos GJ, Cohen MJ: Supraclavicular central venous catheterization. Techniques and experience in 250 cases. Wisc Med J 1981; 80:36-38〕 Accelerated Seldinger Technique, intraosseous infusion, as well as the use of ultrasound guidance for placement of central venous catheters without using the cutdown technique.〔Teichgraber UK, Benter T, Gebel M, et al: A sonographically guided technique for central venous access. AJR Am J Roentgenol 1997; 169:731-733〕〔Randolph AD, Cook DJ, Gonzales CA, et al: Ultrasound guidance for placement of central venous catheters: A meta-analysis of the literature. Crit Care Med 1996; 24:2053-2058〕〔Sabba JA, Hedges JR: Ultrasonographic guidance for internal jugular vein cannulation: An educational imperative; a desirable practice alternative. Ann Emerg Med 2006; 48:548-550〕 ==Procedure== The skin is cleaned, draped, and anesthetized if time allows. The greater saphenous vein is identified on the surface above the medial malleolus, a full-thickness transverse skin incision is made, and 2 cm of the vein is freed from the surrounding structures. The vessel is tied closed distally, the proximal portion is transected (venotomy) and gently dilated, and a cannula is introduced through the venotomy and secured in place with a more proximal ligature around the vein and cannula. An intravenous line is connected to the cannula to complete the procedure.
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