Safely repositioning dual-lumen ECMO cannulas with a transfemoral lasso snare

Perfusion ◽  
2020 ◽  
pp. 026765912096903
Author(s):  
Erika R O’Neil ◽  
Ryan D Coleman ◽  
Adam M Vogel ◽  
Corey A Chartan ◽  
Kamlesh U Kukreja
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real Time ◽  
Internal Jugular Vein ◽  
Pediatric Patients ◽  
Jugular Vein ◽  
Limb Ischemia ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
The Right ◽  
Fluoroscopy Guidance ◽  
Vv Ecmo

Introduction: Dual-lumen cannulas were designed to provide venovenous extracorporeal membrane oxygenation (VV ECMO) with single-vessel access. Anatomic and size considerations may make appropriate placement challenging in children. Dual-lumen cannulas are repositioned in 20–69% of pediatric patients, which can be difficult without transient discontinuation of ECMO support. Methods: We repositioned three dual-lumen ECMO cannulas introduced via the right internal jugular vein using a transfemoral snare technique under real-time ultrasound and fluoroscopy. Results: Two of three patients were supported on VV ECMO and one on veno-veno-arterial (VV-A) ECMO. Two of the three patients had their dual-lumen cannula repositioned under ultrasound and fluoroscopy guidance and one was repositioned just with ultrasound. No patient experienced a complication from the transfemoral snare technique such as femoral hematoma, hemorrhage or limb ischemia. Conclusion: We describe three patients who successfully had dual-lumen cannulas repositioned without cessation of ECMO using a transfemoral “lasso” technique.

scholarly journals Superior vena cava syndrome during veno-venous extracorporeal membrane oxygenation for COVID-19

Perfusion ◽  
2021 ◽  
pp. 026765912098797
Author(s):  
Rafal Kopanczyk ◽  
Omar H Al-Qudsi ◽  
Asvin M Ganapathi ◽  
Bethany R Potere ◽  
Paul S Pagel
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Membrane Oxygenation ◽  
Svc Syndrome ◽  
The Right ◽  
Vv Ecmo

Superior vena cava (SVC) syndrome is typically associated with malignant tumors obstructing the SVC, but as many as 40% of cases have other etiologies. SVC obstruction was previously described during veno-venous extracorporeal membrane oxygenation therapy (VV ECMO) in children. In this report, we describe a woman with adult respiratory distress syndrome resulting from infection with coronavirus-19 who developed SVC syndrome during VV ECMO. A dual-lumen ECMO cannula was inserted in the right internal jugular vein, but insufficient ECMO circuit flow, upper body edema, and signs of hypovolemic shock were observed. This clinical picture resolved when the right internal jugular vein was decannulated in favor of bilateral femoral venous cannulae. Our report demonstrates that timely recognition of clinical signs and symptoms led to the appropriate diagnosis of an uncommon ECMO complication.

scholarly journals Ultrasound-guided anatomical evaluation and percutaneous cannulation of the right internal jugular vein in infants <4000 g

2019 ◽  
Vol 21 (1) ◽  
pp. 92-97 ◽  
Author(s):  
Filiz Uzumcugil ◽  
Aysun Ankay Yilbas ◽  
Basak Akca
Keyword(s):  
Carotid Artery ◽  
Real Time ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Anatomical Variation ◽  
Complication Rates ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Vein Access ◽  
The Right

Background: The commonly preferred right internal jugular vein was investigated in terms of its dimensions, the relationship between its dimensions and anthropometric measures, and the outcomes of its cannulation in infants. Data regarding its position with respect to the carotid artery indicated anatomical variation. Aim: The aim of this study was to share our observations pertaining to the anatomy and position of the right internal jugular vein with respect to carotid artery using ultrasound and our experience with ultrasound-guided right internal jugular vein access in neonates and small infants. Materials and methods: A total of 25 neonates and small infants (<4000 g) undergoing ultrasound-guided central venous cannulation via right internal jugular vein within a 6-month period were included. Ultrasound-guided anatomical evaluation of the vein was used to obtain the transverse and anteroposterior diameters, the depth from skin and the position with respect to the carotid artery. Real-time ultrasound-guided central cannulation success rates and complication rates were also obtained. The patients were divided into two groups with respect to their weight in order to compare both the position and the dimensions of right internal jugular vein and cannulation performance in infants weighing <2500 g and ⩾2500 g. Results: The position was lateral to the carotid artery in 84% of all infants and similar in both groups. The first-attempt success rates of cannulation were similar (70% vs 73.3%) in both groups, with an overall success rate of 88%. Conclusion: Right internal jugular vein revealed a varying position with respect to carotid artery with a higher rate of lateral position. The presence of such anatomical variation requires ultrasonographic evaluation prior to interventions and real-time guidance during interventions involving right internal jugular vein.

Acute upper limb ischemia as a complication of tunneled hemodialysis catheter placement via the right internal jugular vein

2021 ◽  
pp. 112972982110150
Author(s):  
Ahmet Can Topcu
Keyword(s):  
Internal Jugular Vein ◽  
Upper Limb ◽  
Jugular Vein ◽  
Present Report ◽  
Limb Ischemia ◽  
Internal Jugular Vein Cannulation ◽  
Av Fistula ◽  
Hemodialysis Catheter ◽  
Vein Cannulation ◽  
The Right

Arterial injury during internal jugular vein cannulation can cause devastating complications such as stroke, hematoma, hemothorax, pseudoaneurysm, AV fistula, or even death. Acute upper limb ischemia caused by inadvertent arterial puncture during internal jugular vein cannulation has been rarely reported. The present report describes the case of a patient who experienced right upper limb ischemia caused by subclavian artery thrombosis developed during attempted placement of a tunneled hemodialysis catheter via the right internal jugular vein. The patient underwent an emergency brachial embolectomy and recovered uneventfully.

scholarly journals Surgical extraction after thrombosis around the Avalon dual lumen cannula

2014 ◽  
Vol 96 (1) ◽  
pp. e01-e03 ◽  
Author(s):  
V Kalem ◽  
D Buchwald ◽  
J Strauch ◽  
A Sidiropoulos ◽  
R Meindl ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Jugular Vein ◽  
Surgical Removal ◽  
Continuous Administration ◽  
Membrane Oxygenation ◽  
Respiratory Parameters ◽  
Surgical Extraction ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Spinal Contusion ◽  
The Right

The use of a dual lumen cannula (DLC) for venovenous extracorporeal membrane oxygenation (ECMO) has several advantages and reports of complications are rare. We present a case of thrombosis around and inside the Avalon Elite™ bicaval DLC (Avalon Laboratories, Rancho Dominguez, CA, US), for which simple removal by retraction was impossible. A 30-year-old man had experienced an unstable C6/7 fracture with spinal contusion and haematoma in the spinal canal with incomplete neurological paraplegia and thoracic trauma. He developed acute respiratory failure due to posttraumatic systemic inflammatory response syndrome and venovenous extracorporeal membrane oxygenation (ECMO) support was indicated. The cannulation was performed with an Avalon Elite™ cannula (31Fr) in the right jugular vein under fluoroscopy. After 18 days of ECMO therapy, despite the continuous administration of heparin (400iu/h), ECMO was discontinued because of the formation of a massive thrombus in the oxygenator. At that time, the patient’s haemodynamic and respiratory parameters were stable, and we were able to induce a rapid weaning from ECMO. The surgical removal of the cannula became necessary and was performed using a small neck incision without complications. We report this case to emphasise that any resistance encountered during an attempt to extract the Avalon Elite™ cannula may cause serious complications. In such cases, surgical removal must be considered.

scholarly journals Establishment of a venovenous extracorporeal membrane oxygenation in a rat model of acute respiratory distress syndrome

Perfusion ◽  
2021 ◽  
pp. 026765912110314
Author(s):  
Yongnan Li ◽  
Jian Huang ◽  
Rongzhi Zhang ◽  
Shixiong Wang ◽  
Xingdong Cheng ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Rat Model ◽  
Distress Syndrome ◽  
Blood Gas ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
The Right ◽  
Vv Ecmo

Introduction: Venovenous extracorporeal membrane oxygenation (VV ECMO) is now considered a reasonable option to salvage acute respiratory distress syndrome (ARDS). However, we lack a rodent model for experimental studies. This study was undertaken to establish an animal model of VV ECMO in ARDS rats. Methods: A total of 18 Sprague-Dawley (SD) rats (350 ± 50 g) were used in this study. Using a rat model of oleic acid (OA)-induced ARDS, VV ECMO was established through cavoatrial cannulation of the right jugular vein for venous drainage and venous reinfusion with a specially designed three-cavity catheter. Continuous arterial pressure monitoring was implemented by using a catheter through cannulation of the right femoral artery. The central temperature was monitored with a rectal probe. Arterial blood gas monitoring was implemented by a blood gas analyzer at three-time points: at baseline, 1-hour (after OA modeling), and 3.5-hour (after VV ECMO support). Lung tissue and bronchoalveolar lavage fluid were harvested respectively for protein concentration and pulmonary histologic evaluation to confirm the alleviation of lung injury during VV ECMO. Results: Following ARDS induced by OA, ten rats were successfully established on VV ECMO without failure and survived the ECMO procedure. VV ECMO alleviated lung injury and restored adequate circulation for the return of lung function and oxygenation. VV ECMO was associated with decreased lung injury score, wet/dry weight ratio, and fluid leakage into airspaces. Conclusion: We have established a reliable, economical, and functioning ARDS rat model of VV ECMO.

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