medial malleolus saphenous vein incision

1. The patient has severe trauma, extensive burns, major bleeding, severe infection or emergency situations such as shock and dehydration. In order to quickly establish an infusion channel for various liquids and salvage drugs, venous puncture is unsuccessful or the infusion rate cannot be guaranteed. A phlebectomy should be performed immediately. 2. In the case of major surgery, venipuncture is difficult or the infusion rate is poor. Treatment of diseases: burn shock, hemorrhagic shock Indication 1. The patient has severe trauma, extensive burns, major bleeding, severe infection or emergency situations such as shock and dehydration. In order to quickly establish an infusion channel for various liquids and salvage drugs, venous puncture is unsuccessful or the infusion rate cannot be guaranteed. A phlebectomy should be performed immediately. 2. In the case of major surgery, venipuncture is difficult or the infusion rate is poor. Preoperative preparation 1. Local skin cleansing and disinfection. 2. Prepare the infusion set, and prepare the venous cannula of various calibers, among which the soft hose has better effect. Surgical procedure 1. Incision: In the first side of the internal malleolus, make a slit parallel or perpendicular to the direction of the vein. It should be about 2cm long. Do not use excessive force when cutting the skin to avoid cutting the vein. 2. Separation of veins: After incision of the skin, the subcutaneous tissue was separated by a hemostatic forceps along the direction of the blood vessel, and the vein was found, separated by about 1 cm, and then picked up with a hemostatic forceps. In patients with severe shock and dehydration, the veins are wilted and not easily recognizable, or the veins are not easily found due to improper incision or deep separation. At this time, the incision can be appropriately enlarged and carefully searched at the edge of the internal hemorrhoid. 3. Ligation of the distal end of the vein: After the vein is picked up, a hemostatic forceps is used to guide a section of the vein behind the vein, and the distal end of the vein is ligated, and another section of the thread is introduced through the proximal end without ligation. Be careful to peel off the tissue around the vein to avoid ligating the saphenous nerve parallel to it, causing local long-term pain after surgery. 4. Cut the vein: pull the distal ligature of the vein, lift the vein and tighten it slightly. Use a sharp small scissors to cut the vein wall 1/3~1/2 obliquely about 1cm proximal to the ligature. Be careful not to cut the blood vessels. 5. Intubation: Lift the distal ligature line with your left hand, and align the tube end of the appropriate plastic tube or rubber tube with the right hand perpendicularly to the venous incision, gently insert it into the venous cavity, and let the tube end reach the side wall of the blood vessel, then follow the trend The contralateral wall slid the tube end up into the proximal venous tube. Generally inserted 6 to 7 cm deep. It can also be inserted with a venous incision needle. The procedure should be light and accurate when intubating so as not to tear or break the vein or insert the catheter into the interlayer of the venous wall. If the above situation occurs, the incision is enlarged, and another incision is made at the proximal end of the original vein incision to re-intubate. If the vein wall has collapsed and the catheter cannot be inserted, the upper edge of the vascular incision can be gently lifted with a miniature hemostatic forceps. After the incision is opened, the cannula is inserted. 6. Ligation of the vein near the heart: connect the catheter to the infusion bottle. If the fluid is input smoothly, the wire near the heart can be tightened at the catheter site to prevent leakage or leakage. 7. Suture the incision, fix the cannula: suture the skin incision intermittently, and one of the sutures will ligation the catheter together to prevent it from falling off. Cover the incision with sterile gauze.

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