Cannulation Techniques and Strategies Flashcards
7 cards from real ECMO practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Cannulation Techniques and Strategies flashcards as text
During femoral veno-arterial ECMO cannulation, what is the primary concern when selecting the arterial cannula size?
Answer: Maximizing flow while minimizing distal limb ischemia risk
Femoral arterial cannula selection balances adequate ECMO flow with preservation of native limb perfusion to prevent distal ischemia.
What is the purpose of a distal perfusion cannula (DPC) in femoral VA-ECMO?
Answer: To prevent ipsilateral lower limb ischemia
A DPC is placed in the superficial femoral artery to perfuse the limb distal to the ECMO arterial cannula, preventing ischemia.
Which ultrasound view is most useful for confirming guidewire position in the inferior vena cava during femoral venous cannulation?
Answer: Subcostal or transesophageal bicaval view
The subcostal or TEE bicaval view provides direct visualization of the guidewire and cannula tip within the IVC and right atrium.
In percutaneous cannulation, serial dilation of the vessel is performed to:
Answer: Gradually expand the access site to accommodate the final cannula
Sequential dilators progressively enlarge the puncture site so the large-bore ECMO cannula can be inserted without tearing the vessel.
When transitioning from peripheral VA-ECMO to central cannulation, what is the main hemodynamic advantage?
Answer: Elimination of differential hypoxia by delivering oxygenated blood centrally
Central aortic return eliminates the mixing zone issue seen in peripheral VA-ECMO, preventing differential (Harlequin) hypoxia.
What landmark is used to estimate the optimal venous cannula tip position in the right atrium during fluoroscopic-guided femoral VV-ECMO cannulation?
Answer: The carina or right mainstem bronchus at the cavoatrial junction
Fluoroscopically, the cavoatrial junction correlates with the level of the carina, guiding optimal venous drainage cannula tip placement.
Which complication is most specifically associated with axillary artery cannulation for VA-ECMO compared to femoral artery cannulation?
Answer: Brachial plexus injury
The brachial plexus lies adjacent to the axillary artery, making nerve injury a specific risk of this cannulation approach.