The introduction of medications into the bloodstream of a person through intravenous injection has long been a common practice. Thanks to this administration of drugs, a quick therapeutic effect is achieved. The collapsed veins, as well as their fragile walls, make injection difficult. 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 performed 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 joint of the bones of the lower leg with the foot or in the elbow bends.
It is shown with:
- thin or weakly visible through the skin veins in children and overweight people;
- spasm of blood vessels;
- the introduction of nutrients into the body by intravenous infusion;
- the need for prolonged intravenous infusion of drugs.
The procedure is contraindicated in the presence of a skin, purulent rash in the area of the alleged incision, as well as with thrombosis.
Tools
The list of instruments for venesection is as follows:
- surgical knife;
- clamps to stop bleeding;
- anatomical and surgical tweezers;
- scissors with thin branches;
- needle holders;
- silk and catgut ligatures;
- sharp hooks;
- syringe or system for intravenous infusion;
- needles for anesthesia;
- vascular catheters.
In addition, the procedure requires:
- 50 ml of 0.25-0.5% novocaine solution;
- towels or sheets;
- latex gloves;
- dressing;
- gauze napkins and balls.
The preparation of the venesection kit is the responsibility of the nurse of the intensive care unit. After each procedure, she must prepare a new dressing material, rinse and disinfect the tools, and then dry and wrap them with a clean sheet and put in a bin for subsequent sterilization (in a special compartment or in an autoclave).
A set of instruments for venesection must be prepared in advance. Often the procedure is needed for seriously ill patients, and the preparation and processing measures take the lion's share of the time.
Technique
Before surgery, a tourniquet is applied to a limb above the intended incision site. The skin is wiped with alcohol and an alcoholic solution of iodine. The operating area is covered with a sterile sheet or towel.
After procaine anesthesia, a 3-4-centimeter incision is made through a surgical knife and along the vein. Using two tweezers, a vein from the subcutaneous tissue is gently isolated. 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 incised in the area between the two threads. A vein is cut obliquely by 1/2 diameter. Then a blunt needle (cannula) is inserted into her lumen, a second ligature is fixed and tied over it. The ends of the thread lead out. A filled drip infusion system is attached to the catheter. The base of the catheter and the adjacent portion of the rubber tube are attached to the skin with adhesive tape. The wound is sutured.
The cannula is removed as follows: the adhesive plaster is unfastened, the thread knot is dissolved in the center, without removing the seams on the skin, the needle (cannula) is removed. The upper end of the vein is bandaged 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 dressing. Sutures are removed on the 7-8th day.
Venesection is a standard and fairly safe procedure, but only an anesthetist-resuscitator should perform it.
Complications
During the operation, complications such as bleeding and damage to neighboring nerves are possible. The following consequences are possible a bit later:
- thrombosis;
- phlebitis;
- clogged cannula;
- infection of the wound.
Complications during venesection are most likely an 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 assessment by the attending physician. However, with the proper implementation of this procedure and proper care of the wound, it allows you to access a poorly expressed vein for a long period.