Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter IX: Shock and Resuscitation
United States Department of Defense
Peer Review Status: Internally Peer
Reviewed
Multiple sites of venous access, utilizing large-bore, relatively central catheters, provide both rapid infusion and venous pressure monitoring capability. The most commonly employed percutaneous approaches are the internal jugular, the subclavian, and the median basilic veins. If a cutdown is required to achieve large-bore venous access, the median basilic, the greater saphenous in the groin, or the distal saphenous vein at the median malleolus are all easily isolated. Cutdowns performed under emergency conditions are prone to infection and should be discontinued about 24 hours after the emergency. The magnitude and location of the casualty's wounds will influence the site selected for infusion. Except for the most emergent situations, such as cardiac arrest, one should avoid using the common femoral vein for direct access, as the incidence of injury of adjacent structures and deep vein thrombosis can significantly complicate the postoperative course.
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