INTRAVENOUS CUT DOWN

INTRAVENOUS CUT DOWN – Purpose, Principle, Preliminary Assessment, Preparation of the Patient, Equipment, Procedure, After Care and Complication

Cut down is a small incision to insert a cannula or catheters directly into the vein or artery.

Whenever the blood vessels become collapsed and invisible, the veins will have to expose opened and a metal cannula or a piece of fine polythene tubing is inserted into the vein to start an infusion.

PURPOSE

  • To restore and maintain the child’s fluid and electrolyte balance
  • To maintain body homeostasis when the oral intake is inadequate to serve this purpose
  • To measure central venous pressure
  • To administer larger fluid, e.g. cardiac arrest

PRINCIPLE

  • This procedure should carried out by a doctor assisted by a nurse
  • Aseptic technique must be adhered throughout all intravenously procedures to prevent bacterial contamination
  • The single most effective aseptic procedure is good hand washing technique
  • If asepsis is not maintained, local infection, septic phlebitis or septicemia may result

PRELIMINARY ASSESSMENT

  • Check the physician’s order for vein cut down
  • Take written concern from the patient
  • Explain the procedure to the patient
  • Win the cooperation of the patient
  • Arrange all the articles and make sure that it is available in the unit

PREPARATION OF THE PATIENT

  • Explain the procedure to the patient and attendant of the patient. He should conscious to win his confidence and cooperation
  • The site of cut down is prepared as for any major surgery
  • If any hair is present get the site shaved and cleaned
  • The bedding and garments are protected with a Mackintosh and towel
  • Prepare all the articles and strict aseptic technique should be followed

EQUIPMENT

IV Solutions

  • Betadine solutions
  • Alcohol solution 70 degree celcius
  • Hypoallergenic tape 1.2 cm, 2.5 cm
  • Splint
  • Sterile gauze
  • Sterile cotton wool
  • Sterile drapes
  • Sterile cut down tray
  • Syringes 2 ml and 5 ml
  • Needle 25 and 20 gauge
  • The 4/0 black silk suture
  • Assorted size of stereopolyethylene tubing
  • Local anesthesia as prescribed
  • Normal saline 0.9%
  • Sterile gloves according to doctor’s size
  • Restraining devices
  • Sterile gown
  • Gallipot
  • Hand towel
  • Window towel
  • Knife handles No. 15 blades
  • Forceps
  • Scissors
  • Gauze and cotton
  • Needle holders

PROCEDURE

  • Ensure that the physician has explained the procedure to the patient and to gain consent and cooperation
  • Position the patient
  • Open the cut down set and drop the inner pack into the trolley. Physician scrubs his hands thoroughly up to the elbows for a full 3 minutes
  • Dries his hands and grim on the sterile hand towel provided
  • Don a sterile gown and the appropriate sized gloves
  • Opens the dressing packs. Pour betadine and spirit directly from the bottle into the gallipots
  • Under local anesthesia and with aseptic precautions, the skin is incised and the vein is exposed
  • The aneurysm needle is passed under it
  • The loop of the threat is cut down two strands and is formed under the vein
  • Tie the vein to prevent the blood flow
  • The vein is then cut partially between the two ligatures
  • The cannula is passed into the proximal ligature that is tied the cannula in place
  • Wound is closed with interrupted sutures
  • Leave it on a comfortable position

AFTER CARE

  • After the procedure, the nurse should see that it is secured carefully by using the arm board, bandages, adhesive plaster, etc
  • The movement of the patient should not dislodge the IV cannula
  • The cut down site is inspected frequently to detect infiltration of fluid and dislodgement of the cannula
  • The illusion site should be cleaned and dressed after a week sutures are removed

COMPLICATION

  • Infiltration
  • Infusion phlebitis
  • Thrombosis
  • Pyrogenic reaction
  • Air embolism
  • Circulatory overload
  • Shock
INTRAVENOUS CUT DOWN – Purpose, Principle, Preliminary Assessment, Preparation of the Patient, Equipment, Procedure, After Care and Complication
INTRAVENOUS CUT DOWN – Purpose, Principle, Preliminary Assessment, Preparation of the Patient, Equipment, Procedure, After Care and Complication

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