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.
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Figure 2.15 Double lumen “Avalon” catheter through the superior
vena cava with guidewire showing inflow upper and lower ports in the superior
vena cava and inferior vena cava and a small jet of blood flowing through the
mid-port directed at the tricuspid valve. See image of Avalon catheter as well.
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