36425 Venipuncture, cutdown; age 1 or over

Name of the Procedure:

Venipuncture, cutdown; age 1 or over

Common name(s): Venous cutdown, Vein cutdown
Technical/Medical terms: Venous access cutdown, Surgical venipuncture

Summary

Venipuncture cutdown is a procedure used to gain access to a vein when standard venipuncture (needle insertion) is difficult or impossible. This involves making a small surgical incision to directly visualize and access the vein.

Purpose

The procedure addresses conditions where intravenous (IV) access is crucial but challenging, such as in emergencies, dehydration, or collapsed veins. The goal is to establish a reliable venous access for therapies, medications, or fluid administration.

Indications

• Difficulty in obtaining IV access using standard methods
• Emergency situations requiring rapid venous access
• Severe dehydration
• Collapsed veins or poor venous access

Preparation

• The patient may be required to fast if general anesthesia will be used.
• Pre-procedure blood tests and assessments might be needed.
• The skin is cleaned to prevent infection at the incision site.

Procedure Description

1. The patient is positioned, and the selected site (often the ankle or arm) is cleaned.
2. Local anesthesia is administered to numb the area.
3. A small incision is made over the vein.
4. The vein is carefully exposed and accessed using a catheter.
5. The catheter is secured, and the incision is sutured or approximated with adhesive strips.
6. The access site is dressed with a sterile bandage.

Duration

Typically, the procedure takes about 20 to 30 minutes.

Setting

Usually performed in a hospital setting or emergency room.

Personnel

• Surgeons or trained emergency physicians
• Nurses
• Anesthesiologists (if general anesthesia is administered)

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Damage to surrounding tissues or structures
• Venous thrombosis (clot formation)
• Pain or discomfort at the site

Benefits

• Reliable and stable venous access, especially in emergencies.
• Immediate access for delivery of medications and fluids.
• Reduced delays in critical care management.

Recovery

• Keep the incision site clean and dry.
• Follow-up visits to check the healing of the incision.
• Mild pain or discomfort can be managed with over-the-counter painkillers.
• Patients can typically resume normal activities within a few days, but should avoid strenuous activities until cleared by their healthcare provider.

Alternatives

• Peripheral IV insertion (if feasible)
• Central venous catheterization
• Intraosseous (bone) access
• Each alternative has its own risks and benefits, often depending on the urgency and patient’s condition.

Patient Experience

• During the procedure: Minimal discomfort due to local anesthesia; possible pressure sensation.
• After the procedure: Mild tenderness or swelling at the site; pain manageable with medication.
• Regular monitoring and care instructions will be provided to ensure a comfortable recovery.