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what is the current take on peripheral venous cutdowns.. as against central lines are they primitive/obsolete.. would be greatful on a few refrences too thanks

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hey rushad
well the only one place where i know venous cutdowns are good to do is in burns... and that too where significant expertise or area of body is unavailable for a central venous access.
central lines are far easier to do.

but then again... a peripheral venous access is always the best for fluid resusc.
remember the rate of the fluid flow is indirectly proportional to the length of the catheter placed.
so as for my clinical practice i would resist from doing a peripheral venous cutdown.

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We have been using rapid infusion devices like EIDs (Emergency Infusion Device from Arrow not Electronic Infusion Device) or Abbocaths, which can be used as central lines (mainly femoral) but still facilitating rapid infusion of fluids. They are quick to site and effective too mainly at times when you are struggling to get access but can't find or get one!!!

And don't forget IO access for patients in extremis. This has become even more easy with some of the latest gizmos like EZIO, FAST-1 and BIG (already out of fashion!!!)

When your options are limited, venous cut-down could still be the last resort.....