Klofas E
Department of Surgery, Stanford University, California 94305-5239, USA.
J Trauma. 1997 Dec;43(6):985-7. doi: 10.1097/00005373-199712000-00025.
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.
大隐静脉切开术长期以来一直是创伤患者静脉通路的主要方法。然而，在过去几年中，其受欢迎程度和使用频率显著下降。在大多数情况下，采用Seldinger技术的经皮股动脉插管已基本取代切开术，成为获取血管通路的首选方法。然而，仍有一组重症患者，通常没有可触及的股动脉搏动，在这些患者中，即使不是不可能，经皮股静脉置管也很困难。大隐静脉切开术对这些患者可能是救命的，前提是医生能够保留有效实施切开术的技能。随着时间的推移，这种可能性会更小，因为新版《高级创伤生命支持》教科书将使大隐静脉切开术成为一项“可选”技能，由课程主任自行决定是否教授。本文介绍了一种使用Seldinger导丝引导扩张器的更快、更有效的大隐静脉切开术。还介绍了一种有效且成本低廉的模型，用于教授该手术和保留技能。
