Cutdown????

anne74 · Oct 10, 2006

I don't know. Never heard of it either.

ukstudent · Oct 10, 2006

It is when they can't find a vein and cut down into the tissue with a scalpel to find a vein.

anne74 · Oct 10, 2006

Wow. That seems a little extreme with a high risk of bleeding and infection. It seems like there are a lot of other options before doing that - like placing a central line. ????

LisaRn21 · Oct 10, 2006

that makes sense!!! Pt had a femoral line and it was pulled due to infection...at tthe time they thought he was septic so hmm I don't know why not another central line.. the doc kept saying no more centrals..

TazziRN, RN · Oct 10, 2006

Cutdowns used to be really common in pedi criticals, before IO's.

augigi, CNS · Oct 10, 2006

Maybe ask your doc? A cutdown was generally a last resort in my unit.

Mr. Grumpy · Oct 10, 2006

Sounds like the pt. is gonna die. Cut-downs should be like very last resort. Should be history like last resort. The doctor was probably concerned about infection (systemic). Now, he just gave another link to the infection chain. Wasn't there. I feel that the nurse should have advocated for a ID consult and new central line (in OR). Since the doctor probably didn't use sterile technique on the first one, he is probably worried about introducing more bugs on his second try. Now, he has introduced the outside to the inside. :uhoh3:

RazorbackRN, BSN, RN · Oct 10, 2006

Sounds like the pt. is gonna die. Cut-downs should be like very last resort. Should be history like last resort. The doctor was probably concerned about infection (systemic). Now, he just gave another link to the infection chain. Wasn't there. I feel that the nurse should have advocated for a ID consult and new central line (in OR). Since the doctor probably didn't use sterile technique on the first one, he is probably worried about introducing more bugs on his second try. Now, he has introduced the outside to the inside.

Yeah, but one of the risks of having a CVL placed is infection. Granted a break in sterile technique could cause this, however, just because it is infected doesn't mean that sterile technique was broken during placement.

augigi, CNS · Oct 10, 2006

He did say "probably" - and it is the most common reason in most of the evidence-based literature I've seen.

RazorbackRN, BSN, RN · Oct 10, 2006

He did say "probably" - and it is the most common reason in most of the evidence-based literature I've seen.

That really surprises me.

I had read (sorry, I don't have the article link any longer) several months ago in the American Journal of Infection Control that not changing the overwire/guidewire frequently enough was the most contributing cause of infection in a CVL.

Thanks for the info.

NAVY RN · Oct 10, 2006

In ATLS I was taught to do cutdowns, but this should only be used after a peripheral/central/intraosseous access attempt has failed. The most common place to do a cutdown is at the great saphenous (sp?) vein at the ankle. If you're doing a cutdown, infection is the last thing you are worried about. At this point saving the person's life is the priority.