Percutaneous Cannula Placement
◆Prior to performing venous-venous extracorporeal membrane oxygenation (ECMO), appropriately sized vessels and ECMO configuration (e.g., femoral-femoral, femoral-jugular) must be chosen to achieve maximum ECMO flow to support the patient.
◆ The femoral vein is punctured with an 18-G needle by palpating the femoral artery and directing the needle just medial to the artery or via ultrasound. A J-tipped guidewire is advanced through the needle and should be visualized in the right atrium–IVC junction. A series of graduated dilators are used, and the venous cannula is placed over the guidewire. A similar approach is achieved for the jugular vein.
◆ A novel method of achieving venous-venous ECMO is via a double-lumen catheter, which can be placed in the right jugular vein. Ultrasound-guided venous puncture of the right jugular vein is achieved with an 18-G needle, and a stiff, J-tipped guidewire is placed and should be anchored deep into the IVC. TEE is essential, but to minimize complications, fluo- roscopy is required.6 A series of graduated dilators are used, and the double-lumen catheter is placed so that the upper and lower drainage holes are located at the SVC and IVC, respectively (Fig. 2.15). The return (oxygenated blood) port is found in the mid–right atrium, and the oxygenated blood is directed toward the tricuspid valve.