ECMO Cannulation Techniques and Strategies 3

Question 1

In neonatal ECMO, the right internal jugular vein is the preferred venous access site primarily because:

Accepted Answer

It provides the most direct path to the right atrium

Answer

The right internal jugular vein offers the most direct, shortest course to the right atrium, optimizing drainage cannula positioning in neonates.

Question 2

What is 'chattering' of the ECMO circuit, and which cannula is most often implicated?

Accepted Answer

Intermittent venous line collapse due to inadequate preload at the drainage cannula

Answer

Chattering refers to cyclical collapse and re-expansion of the venous drainage line when the cannula cannot provide sufficient blood to the pump.

Question 3

During cannulation for VV-ECMO using a bicaval dual-lumen cannula (e.g., Avalon), the return lumen is designed to direct oxygenated blood toward:

Accepted Answer

The tricuspid valve

Answer

The return lumen of a bicaval dual-lumen cannula is angled to direct flow across the tricuspid valve into the right ventricle, reducing recirculation.

Question 4

Why is systemic anticoagulation typically administered before the first dilator is placed during ECMO cannulation?

Accepted Answer

To prevent clot formation on instrumentation and in the cannula

Answer

Heparin is given prior to dilation to prevent thrombus formation on the guidewire, dilators, and cannula surfaces during insertion.

Question 5

In a patient undergoing right internal jugular VV-ECMO cannulation, the drainage cannula tip should ideally rest at:

Accepted Answer

The right atrium-IVC junction

Answer

The drainage tip at the IVC-RA junction maximizes venous return from both the IVC and RA while avoiding right ventricular irritation.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Cannulation Techniques and Strategies 3