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
In neonatal ECMO, the right internal jugular vein is the preferred venous access site primarily because:
Answer: It provides the most direct path to the right atrium
The right internal jugular vein offers the most direct, shortest course to the right atrium, optimizing drainage cannula positioning in neonates.
What is 'chattering' of the ECMO circuit, and which cannula is most often implicated?
Answer: Intermittent venous line collapse due to inadequate preload at the drainage cannula
Chattering refers to cyclical collapse and re-expansion of the venous drainage line when the cannula cannot provide sufficient blood to the pump.
During cannulation for VV-ECMO using a bicaval dual-lumen cannula (e.g., Avalon), the return lumen is designed to direct oxygenated blood toward:
Answer: The tricuspid valve
The return lumen of a bicaval dual-lumen cannula is angled to direct flow across the tricuspid valve into the right ventricle, reducing recirculation.
Why is systemic anticoagulation typically administered before the first dilator is placed during ECMO cannulation?
Answer: To prevent clot formation on instrumentation and in the cannula
Heparin is given prior to dilation to prevent thrombus formation on the guidewire, dilators, and cannula surfaces during insertion.
In a patient undergoing right internal jugular VV-ECMO cannulation, the drainage cannula tip should ideally rest at:
Answer: The right atrium-IVC junction
The drainage tip at the IVC-RA junction maximizes venous return from both the IVC and RA while avoiding right ventricular irritation.
What is the Seldinger technique in the context of ECMO cannulation?
Answer: Needle puncture followed by guidewire insertion, then cannula advancement over the wire
The Seldinger technique involves placing a guidewire through an introducer needle, then advancing dilators and ultimately the cannula over the wire.
Which factor most increases the risk of acute aortic dissection during femoral arterial cannulation for ECMO?
Answer: Pre-existing aortic aneurysm or dissection
Pre-existing aortic pathology such as an aneurysm or dissection greatly increases the risk of propagation or injury during retrograde arterial cannulation.