TECHNIQUE FOR INSERTION OF PLASTIC CATHETER INTO SAPHENOUS VEIN

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Abstract
FOR THE sure delivery of fluid into the blood stream of a patient, it sometimes becomes necessary to place a plastic tube in a selected vein. This procedure can be accomplished by anyone who possesses a moderate knowledge of anatomy and sterile technique and is familiar with the apparatus involved. In infants and obese children the isolation and catheterization of a suitable vein is more difficult.[See FIG. 1., FIG. 2. in Source PDF] On most pediatric services it is the responsibility of the pediatric resident staff to perform such "cutdown" procedures, when indicated. In many community hospitals this task falls to the lot of the busy attending pediatrician. In the middle of the night, with a tiny patient in profound shock, the insertion of a catheter into a vein may be a demanding assignment. In such a situation the attempts of the uninitiated are [See FIG 3 In Source PDF] usually characterized by a generous incision, with much spreading and dissection of the tissues. This invites infection; in addition, any significant delay may be costly. A saphenous vein "cutdown" is frequently used in conjunction with major operative procedures at the Children's Medical Center. Saphenous phlebitis is rare, and its occurrance in a child does not have the more serious connotation that it does in the adult. Under the stimulus of good-humored chiding by the senior residents, each incoming junior house officer acquires a flare in the art of cannulating veins. The time elapsing from preparation of the skin to bandaging averages under 5 minutes. The factors responsible for such rapidity are: an anesthetized patient, repetition of a routine, and an exact knowledge of the anatomy involved. Four anatomic characteristics make the saphenous vein ideal for cannulation under direct vision (Fig. 2). These are: 1) its constancy (one can depend upon its presence just anterior to the medial malleolus); 2) it is the only structure of importance in this location (there are no arteries or tendons in the space immediately anterior to the malleolus; the tiny saphenous nerve should offer no confusion, and its division is of no great moment); 3) the vein lies on tough periosteum; and 4) its elasticity allows it to be withdrawn from a short incision without danger of rupture. Each of these facts serves importantly in the delivery of the vein, which, after all, is the key to the "cutdown" procedure.

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