Venous cutdowns in the emergency department

Venous cutdown is an essential skill for emergency physicians. Trauma patients in hypovolemic shock with peripheral venous collapse should have one upper and one lower extremity cutdown with large-bore catheters to facilitate fluid replacement. The greater saphenous, basilic, cephalic, external jugular and brachial veins are compared for advantages and disadvantages as cutdown sites. Knowledge of the anatomy is critical in performing a cutdown and avoiding injury to other structures in the area. A protocol describes a method for safe, rapid venous cutdown.