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  • In general, the cutdown procedure is used for the operative placement of an intermediate or long-term central catheter or in an emergency setting when percutaneous access is unachievable.

Absolute

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  • Infection on the skin over the area of the intended cutdown.

  
  

  • Percutaneous access that can be safely achieved.

Relative

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  • Bleeding disorder.

  
  

  • Coagulopathy.

  
  

  • Irritation of skin over area of the intended cutdown.

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  • Antiseptic solution.

  
  

  • Sedative or analgesic.

  
  

  • Surgical protective wear (sterile gloves, mask, hat, sterile gown).

  
  

  • Tourniquet.

  
  

  • 4–6 sterile towels.

  
  

  • 10-mL syringe, 20–25-gauge needle, 0.5% lidocaine.

  
  

  • 2 scalpels (#10 and #11 blades).

  
  

  • 4 × 4 gauze sponges.

  
  

  • 1 curved hemostat.

  
  

  • 1 forceps.

  
  

  • Single-toothed spring retractors (optional).

  
  

  • Sutures, 4-0 silk ties (1 package), 4-0 nylon suture with cutting needle (1 package).

  
  

  • Needle holder.

  
  

  • 2 cutdown catheters (depends on size of child and vein; can use between a #14 and #22 gauge).

  
  

  • Sterile dressing.

  
  

  • Topical antibiotic ointment.

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  • Bleeding.

  
  

  • Infection.

  
  

  • Thrombosis.

  
  

  • Arterial or nerve injury.

  
  

  • Air embolus, catheter migration or erosion, and arrhythmias (more often seen with central venous access cutdowns).

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  • Apply eutectic mixture of local anesthetic (EMLA) over intended incision site 30 minutes prior to procedure, and administer morphine or diazepam for sedation.

  
  

  • Prepare a large area of skin over the intended dissection site with antiseptic solution and drape the area with sterile towels.