In the severely ill patient, multiple cutdowns may be required when venipuncture sites have been exhausted. Occasionally these vessels will be thrombosed, but before discarding any site, one should consider catheterization of the vessel or its tributary in the reverse direction.
A 60%, third-degree burn patient had all of the usual cutdown sites involved with eschar except the ankles. These locations soon became exhausted, a cutdown on each side lasting several days and resulting in a superficial phlebitis. In preparation for her ninth debridement and grafting, an intravenous line was required. A second cutdown over the right superficial saphenous vein just anterior to the medial malleolus revealed a thrombosed vessel. However, a tributary to this vein just below the line of incision appeared patent. Isolating this vessel with a 000 silk distal and proximal, a No. 18 Intravenous catheter was threaded into the vein in the distal direction. When connected
Wayne R, Carnazzo AJ. Reverse Catheterization of a Thrombosed Vein. Arch Surg. 1973;106(1):112. doi:10.1001/archsurg.1973.01350130108026