Intensive Care Medicine

, Volume 39, Issue 1, pp 151–154 | Cite as

Pressure-guided positioning of bicaval dual-lumen catheters for venovenous extracorporeal gas exchange

  • Thomas Langer
  • Vittoria Vecchi
  • Slava M. Belenkiy
  • Leopoldo C. Cancio
  • Luciano Gattinoni
  • Andriy I. Batchinsky
Physiological and Technical Notes



Bicaval dual-lumen catheters allow for single-site cannulation venovenous extracorporeal gas exchange and facilitate early mobilization of patients. Using these catheters blood is drained from the superior and inferior venae cavae, pumped through a respiratory membrane, and returned into the right atrium. The insertion of these catheters is challenging as their correct positioning is fundamental to reduce recirculation and avoid severe complications. We describe here a new technique for the positioning of bicaval dual-lumen catheters.

Materials and methods

The right internal jugular vein was percutaneously cannulated in nine sheep. The distance between skin and tricuspid valve was measured from the point of pressure change in the waveform of a Swan–Ganz catheter being retracted from the right ventricle into the right atrium. The atrium-tricuspid valve-ventricle axis was determined by observing the fluctuations of the tip of the Swan–Ganz entering the ventricle during fluoroscopy. A bicaval dual-lumen catheter was placed on the basis of these evaluations and connected to an extracorporeal respiratory support system.


The position of the catheter was verified at necropsy approximately 18 h after insertion. In all cases the catheter was correctly placed, with the central port situated in front of the tricuspid valve.


The described technique may help to position bicaval dual-lumen catheters for venovenous extracorporeal gas exchange without the use of transesophageal echocardiography or contrast media during fluoroscopy.


Extracorporeal membrane oxygenation Catheterization Acute respiratory distress syndrome 


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Thomas Langer
    • 1
    • 2
    • 4
  • Vittoria Vecchi
    • 1
    • 3
    • 4
  • Slava M. Belenkiy
    • 1
  • Leopoldo C. Cancio
    • 1
  • Luciano Gattinoni
    • 2
  • Andriy I. Batchinsky
    • 1
  1. 1.US Army Institute of Surgical ResearchSan AntonioUSA
  2. 2.Dipartimento di Fisiopatologia medico-chirurgica e dei trapiantiUniversità degli Studi di MilanoMilanItaly
  3. 3.School of MedicineUniversità degli Studi di MilanoMilanItaly
  4. 4.National Research Council, National AcademiesWashingtonUSA

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