<< Vascular Access in Pediatric Patients in the Emergency Department: Types of Access, Indications, and Complications

Special Circumstances

Venous Cutdown

Because of the wide availability of IO placement, venous cutdown has become an infrequent method of emergency vascular access if percutaneous methods fail. However, this procedure remains within the purview of the emergency clinician.

The saphenous vein is a well-described and fairly safe access point; it is described as the “classic” pediatric cutdown.94,95 The saphenous vein is the longest vein in the body, originating from the medial marginal vein of the foot and crossing 1 to 2 centimeters anterior and 1 to 2 centimeters superior to the medial malleolus as it continues superficially along the anteromedial aspect of the leg before joining the femoral vein.96 Other common sites for cutdown include the greater saphenous vein nearer the groin, and the basilica vein above the elbow.96

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