Peripheral venous cutdown.

Timely establishment of vascular access is a critical component of the care of the acutely ill or injured patient. Peripheral venous cutdown, once a mainstay in the care of the severely traumatized patient, has progressively lost favor since the introduction of the Seldinger technique of central venous line placement. In fact, recent editions of the Advanced Trauma Life Support (ATLS) text refer to saphenous venous cutdown as an optional skill to be taught at the discretion of the instructor. In certain patients, percutaneous vascular access may be impossible to achieve or result in unacceptable time delays. In these situations, the ability to rapidly and proficiently perform peripheral venous cutdown techniques may prove invaluable and potentially lifesaving. This article reviews the anatomy of the most common sites used for peripheral venous cutdown, peripheral venous cutdown techniques, and the complications associated with peripheral venous cutdown.