Cite this post as:
Scott Weingart, MD FCCM. More on the Rapid Saphenous Cutdown for Vascular Access in Trauma. EMCrit Blog. Published on May 20, 2015. Accessed on March 22nd 2023. Available at [https://emcrit.org/emcrit/rapid-saphenous-cutdown-for-trauma/ ].
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
Original Release: May 20, 2015
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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What was the joke Cliff Reid gave in his “Own the Resus Room” talk? The saphenous cutdown exists today so you can keep the surgeon busy at the foot of the bed during the resuscitation. I’m just confused about who you could reasonably expect to perform this procedure on. 1. I’m not aware of any IO controversy, although perhaps I’m under-informed. While Dr Stein raises the specter of multiple-extremity fracture as a complication precluding IO access, I’ve not yet found a patient with BL tibial and humeral fractures. I’m not saying they don’t exist. 2. How hypovolemic does a patient… Read more »
I would also love to know what the “controversy” is regarding intraosseous access. Perhaps a patient with a limb fracture?
I am a resident in Chile, IO access is known but unavailable, we have had to use this access at least once, was done by our surgeon with a similar technique. I am glad to learn this in case he is not there next time.
Subclavian not available? EJ? Femoral? U/S guided? This is an old technique, seems a bit silly to keep it in the repertoire when so many other good options exist. i have no idea what the controversy surrounding I/O access is. We use it in multi-system all the time without any problem, especially, if you have two devices, you have 7 points of access…
Always good to hear commentary from all sides, and thanks for taking the time to write! While there are certainly no issues with attempting any of the other techniques that have been mentioned, each with their own advantages, the purpose of the technique Dr Stein demonstrates here (and as Leon mentioned before) is not to supplant those, but rather to provide one more possible method of obtaining venous access when all else has failed. The preamble outlines that this can be attempted in a situation where experienced providers may have already tried other techniques of peripheral and/or central access and… Read more »
Assuming you were teaching this technique to a new EM resident, or realistically any “non-surgeon” provider, what sort of timeline or number of “reps” would you anticipate for even a baseline competency?
Chris Thanks for your question! I think it’s a difficult one to put a number to, just like it’s difficult to put a number to attain competency in other critical but rarely performed procedures that are included in the majority of emergency medicine or EMS curricula. Each individual learner may also need a different number to feel “competent.” How do you attain and maintain competence in these kinds of procedures? Cliff Reid puts forth some great points on just this type of thing, which you can read in a few places such as here: http://bit.ly/1SuvyJF So looking at Cliff’s ten… Read more »
Hello. Sorry for the late comment, but I am curious: In the video Dr. Stein herself starts on the right leg but then actually the saphena magna is just shown on the left leg while a more proximal cut was also done prior. Did you need three tried to find the vein, or did you just do the procedure multiple times for practice or to have the best view for the video? If it takes multiple cuts to even find the vein although it’s done by a highly professional provider, then the procedure does not seem very straightforward to me….… Read more »
My own apologies for the late reply. The multiple cuts were due partially due to editing and partially that the cadaver we utilized was also being used by other learners who were present that day.
As the vein lies in a fairly reliable position, it really just requires one cut to locate and can be rapidly performed.