schematic of CD technique
Definition An incision through skin and subcutaneous tissue into a major blood vessel, usually a vein–hence, venous cutdown (CD), to facilitate rapid and direct vascular access, followed by insertion of a cannula under direct visualisation.
CDs are waning in popularity; intraosseous infusion is an increasingly preferred strategy for rapid fluid management of trauma and shock.
• Basilic vein–above elbow
• Cephalic vein–at shoulder
• External jugular vein–at neck
• Saphenous vein (most commonly used)–at ankle
CDs are required when a percutaneous placement of a venous cannula is not possible, there is no good vein, in emergent situations, or in the face of global venous sclerosis–as occurs with long-term IV drug use; any peripheral vein can be used.
Complications Cellulitis, haematoma, phlebitis, perforation of posterior wall of vein, venous thrombosis, nerve transection, arterial transection
Synonym Venous cut down