Venous cutdown


  • As an alternative to venipuncture in critically ill patients in need of vascular access, and in whom venipuncture may be difficult



  • When less invasive options for venous access exist
  • Major trauma at target site


  • Overlying soft tissue infection
  • Bleeding diathesis
  • Immunocompromise
  • Extremity injury proximal to the site

Equipment Needed

  • Scalpel with 11-blade
  • Curved hemostat
  • Iris scissors
  • 0-0 silk sutures
  • Plastic venous dilator
  • Large bore IV catheter
  • IV tubing
  • Tape


  1. Choose site
    1. Great saphenous vein (most common, usually at the ankle)
    2. Basilic vein
    3. Cephalic vein
  2. Apply tourniquet
  3. Clean skin
  4. Make shallow incision perpendicular to vein course
  5. Bluntly dissect, isolate and mobilize the vein
  6. Use a hemostat to isolate the vein, and pass silk ties under it, proximal and distal to the proposed cannulation site
  7. Tie the distal suture only (or just apply traction without tying)
  8. Incise the vein while retracting the proximal ligature, cutting through 1/3 to 1/2 the diameter of the vein
  9. Use the venous dilator to lift the flap and then advance the catheter into the vein
  10. Attach IV tubing to the catheter
  11. Tie the proximal suture around the vein and catheter
  12. If distal suture not tied, remove it
  13. Tape catheter to skin, close incision


  • Transection of the vein
  • Transection of the artery
  • Bleeding
  • Hematoma
  • Phlebitis
  • Sepsis
  • Thrombus formation
  • Injury to surrounding structures

See Also

Vascular access types

External Links




  1. Roberts, J. R., Custalow, C. B., & Thomsen, T. W. (2019). Roberts and Hedges' clinical procedures in emergency medicine and acute care (Seventh edition.). Philadelphia, PA: Elsevier.

Roberts & Hedges 6e, pp 432-439