The saphenous vein cutdown has long been a mainstay for venous access in the trauma patient. During the past several years, however, its popularity and frequency of use have declined markedly. Percutaneous femoral catheterization using the Seldinger approach has essentially replaced the cutdown as the method of choice for gaining vascular access in most circumstances. There remains a group of critically ill patients, however, often without palpable femoral pulses, in whom percutaneous femoral lines are difficult if not impossible to place. The saphenous vein cutdown can be lifesaving in these patients, provided that physicians can preserve the skill to place the cutdowns efficiently. This will be even less likely in time because the new revision of the Advanced Trauma Life Support textbook will make the saphenous vein cutdown an "optional" skill to be taught at the discretion of the course director. Presented is a faster, more efficient saphenous vein cutdown procedure using a Seldinger wire-guided dilator. Also presented is an effective, inexpensive model for teaching this procedure and for skill preservation.
From the Department of Surgery, Division of Emergency Medicine, Stanford University, Stanford, California.
Address for correspondence: Ed Klofas, MD, Department of Surgery, Division of Emergency Medicine, Stanford University, 300 Pasteur Drive, MSOB X300, Stanford, CA, 94305-5239. No reprints available.