Venous cutdown is a critical medical emergency procedure for nurses to help trauma patients exposed their vein by surgical methods using the steps described below:
Requirements needed on top shelf of the Trolley:
- A sterile receiver with lid containing plain catgut tube 2/0 or 00
- Small bowl with lid containing sterile water for rinsing catgut
- Kidney receiver with lid for syringe and needles
- Sterile bowl containing a dressing towel
- Needles and cannulae as required
- Local anesthetic agent
Instruments drum containing:
- Bard parker handle
- Fine scalpel
- Curved cutting needle
- Nylon thread /silkworm gut
- 2 pairs of scissors one should be fine and sharp pointed
- 2 pairs fine dissecting forceps
- Toothed dissecting forceps
- 2 pairs mosquito artery forceps
- Aneurysm needle
- Blunt hook retractor
HOW TO CARRY OUT A VENOUS CUTDOWN
- The nurse should explain the procedure to the patient or patient’s relatives to make the feel at ease before this process is carried out.
- The trolley is wheeled to the patient’s bedside
- The site for the procedure is selected e.g the leg (saphenous vein) or the elbow (cubital fossa), and the patient is placed on a comfortable position
- The doctor washes his hand and ties a mask
- The nurse opens the sterile tray and using a cheatle forceps hands a sterile towel to the doctor who might have scrubbed his hands. The nurse provides sterile gloves for the doctor, and then pours out the antiseptic lotion for cleaning the skin.
- The subsequent procedure is mainly carried out by the doctor who makes a horizontal cut 2cmdiameter and the veins are identified. This is done by palpitation.
- An artery pulsates; nerve is cool like in texture while a vein is identified after eliminating an artery and a nerve.
- The identified vein is cut half way through with a pair of scissors.
- The lower part of the vein is ligatured with silk while the upper part of it is loosely tied with silk and the lumen left intact.
- The tiny peadiatric butterfly needle with the headdetachedorthe tiny peadiatric nasogastrictube is introduced into the proximal end of the vein.
- The loosely tied silk is now firmly knitted to avoid the tube slipping out.
- The intravenous infusion is hanged on a drip stand and the given set is connected to the tube introduces into the vein.
- The infusion is allowed to flow as required.
- The skin is sutured with silk.
- A dry sterile dressing is applied by the nurse and a tape neatly applied.
- All used apparatus are washed and sent to the sterilization for repacking and sterilization.
- The client is made comfortable and the screen removed.