The introduction of drugs into the human bloodstream through intravenous injection has long been a common practice. Thanks to this administration of drugs, a rapid therapeutic effect is achieved. Collapsed veins, as well as their fragile walls, make it difficult to inject. In such cases, the doctor uses a method such as venesection - this is the opening of the lumen of the vein by incision. The procedure is carried out under conditions of complete sterility.
Indications
Venesection is the exposure and dissection of the venous wall for infusion therapy or diagnostic studies. More often for this procedure, veins are chosen in the area of the articulation of the bones of the lower leg with the foot or in the elbow bends.
She is shown at:
- thin or poorly visible veins through the skin in children and obese people;
- vasospasm;
- introducing nutrients into the body by intravenous infusion;
- need for long-term intravenous infusion of drugs.
The procedure is contraindicated in the presence of skin, purulent rash inarea of the proposed incision, as well as thrombosis.
Toolkit
The list of instruments for venesection is as follows:
- surgical knife;
- clamps to stop bleeding;
- anatomical and surgical tweezers;
- scissors with thin jaws;
- needle holders;
- silk and catgut ligatures;
- sharp hooks;
- syringe or intravenous system;
- anesthetic needles;
- vascular catheters.
In addition, the procedure requires:
- 50 ml 0.25-0.5% novocaine solution;
- towels or sheets;
- rubber gloves;
- dressing material;
- gauze pads and balls.
Preparation of the venesection kit is the responsibility of the intensive care unit nurse. After each procedure, she must prepare a new dressing, rinse and disinfect the instruments, and then dry them and wrap them in a clean sheet and put them in a bix for subsequent sterilization (in a special compartment or in an autoclave).
A set of tools for venesection must be prepared in advance. Often, the procedure is needed for seriously ill patients, and preparation and processing activities take up the lion's share of time.
Technique
Before surgery on a limb above the intended incision siteapply a tourniquet. The skin is wiped with alcohol and an alcohol solution of iodine. The operating area is covered with a sterile sheet or towel.
After novocaine anesthesia, a 3-4 cm skin incision is made with a surgical knife and along the vein. Using two forceps, the vein is carefully isolated from the subcutaneous tissue. Two self-absorbable threads are brought under it. One is moved a little further, bandaged and used as a holder. The second is brought closer to the center, overwhelmed, but not tied. Then a vein is cut in the area between the two threads. The vein is cut obliquely by 1/2 diameter. Then a blunt needle (cannula) is inserted into its lumen, fixed and tied over it with a second ligature. The ends of the thread are brought out. A filled drip line is attached to the catheter. The base of the catheter and the area of the rubber tube adjacent to it are attached to the skin with an adhesive plaster. The wound is being sutured.
The cannula is removed as follows: the adhesive plaster is peeled off, the thread knot is unraveled in the center without removing the sutures on the skin, the needle (cannula) is removed. The upper end of the vein is tied up by tightening the catgut, the ends of the protruding thread are cut off. If the wound does not close, an additional suture is applied, and then a pressure bandage. Stitches are removed on days 7 - 8.
Venesection is a standard and fairly safe procedure, but only an anesthesiologist-resuscitator should perform it.
Complications
During the operation, complications such as bleeding and damage to neighboring nerves are possible. A little later, the followingconsequences:
- thrombosis;
- phlebitis;
- blockage of the cannula;
- wound infection.
Complications of venesection are most likely the exception if the procedure is performed by qualified medical staff.
Conclusion
If venesection is necessary, the indications and consequences that are possible during its implementation are subject to evaluation by the attending physician. However, with proper implementation of this procedure and proper wound care, it allows you to access a poorly defined vein for a long period.
