a two-year-old patient presents to the ed after having fallen in a lake, with a near drowning. the patient is in shock. regular venous access methods have failed, and the emergency department attending physician decides to do a venous cutdown. after a transverse incision over the vein of the patient's ankle is made, a small stab incision is done distal to the first incision. two sutures are placed around the vein. a cannula is passed though the incision of the vein. the skin is closed in layers with sutures.