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

Abstract

Purpose

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.

Results

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.

Conclusions

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.

Keywords

Extracorporeal membrane oxygenation Catheterization Acute respiratory distress syndrome 

References

  1. 1.
    Javidfar J, Brodie D, Wang D, Ibrahimiye AN, Yang J, Zwischenberger JB, Sonett J, Bacchetta M (2011) Use of bicaval dual-lumen catheter for adult venovenous extracorporeal membrane oxygenation. Ann Thorac Surg 91:1763–1768PubMedCrossRefGoogle Scholar
  2. 2.
    Lazar DA, Cass DL, Olutoye OO, Kim ES, Welty SE, Fernandes CJ, Lee TC (2012) Venovenous cannulation for extracorporeal membrane oxygenation using a bicaval dual-lumen catheter in neonates. J Pediatr Surg 47:430–434PubMedCrossRefGoogle Scholar
  3. 3.
    Turner DA, Cheifetz IM, Rehder KJ, Williford WL, Bonadonna D, Banuelos SJ, Peterson-Carmichael S, Lin SS, Davis D, Zaas D (2011) Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach. Crit Care Med 39:2593–2598PubMedGoogle Scholar
  4. 4.
    Wang D, Zhou X, Liu X, Sidor B, Lynch J, Zwischenberger JB (2008) Wang–Zwische double lumen cannula—toward a percutaneous and ambulatory paracorporeal artificial lung. ASAIO J 54:606–611PubMedCrossRefGoogle Scholar
  5. 5.
    Korver EP, Ganushchak YM, Simons AP, Donker DW, Maessen JG, Weerwind PW (2012) Quantification of recirculation as an adjuvant to transthoracic echocardiography for optimization of dual-lumen extracorporeal life support. Intensive Care Med 38:906–909PubMedCrossRefGoogle Scholar
  6. 6.
    van Heijst AF, van der Staak FH, de Haan AF, Liem KD, Festen C, Geven WB, van de Bor M (2001) Recirculation in double lumen catheter veno-venous extracorporeal membrane oxygenation measured by an ultrasound dilution technique. ASAIO J 47:372–376PubMedCrossRefGoogle Scholar
  7. 7.
    Javidfar J, Wang D, Zwischenberger JB, Costa J, Mongero L, Sonett J, Bacchetta M (2011) Insertion of bicaval dual-lumen extracorporeal membrane oxygenation catheter with image guidance. ASAIO J 57:203–205PubMedCrossRefGoogle Scholar
  8. 8.
    Trimlett RH, Cordingley JJ, Griffiths MJ, Price S, Hunter DN, Finney SJ (2011) A modified technique for insertion of dual-lumen bicaval cannulae for venovenous extracorporeal membrane oxygenation. Intensive Care Med 37:1036–1037PubMedCrossRefGoogle Scholar
  9. 9.
    Hirose H, Yamane K, Marhefka G, Cavarocchi N (2012) Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation. J Cardiothorac Surg 7:36PubMedCrossRefGoogle Scholar
  10. 10.
    de Bucourt M, Teichgraber UK (2012) Image guided placement of extracorporeal life support through bicaval dual-lumen venovenous membrane oxygenation in an interventional radiology setting-initial experience. J Vasc Access 13:221–225PubMedCrossRefGoogle Scholar
  11. 11.
    Tabak B, Elliott CL, Mahnke CB, Tanaka LY, Ogino MT (2012) Transthoracic echocardiography visualization of bicaval dual-lumen catheters for veno-venous extracorporeal membrane oxygenation. J Clin Ultrasound 40:183–186PubMedCrossRefGoogle Scholar
  12. 12.
    Crotti S, Lissoni A, Tubiolo D, Azzari S, Tarsia P, Caspani L, Gattinoni L (2012) Artificial lung as an alternative to mechanical ventilation in COPD exacerbation. Eur Respir J 39:212–215PubMedCrossRefGoogle Scholar
  13. 13.
    Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, Olsson KM, Greer M, Sommer W, Welte T, Haverich A, Hoeper MM, Warnecke G (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 185:763–768PubMedCrossRefGoogle Scholar
  14. 14.
    Hoste EA, Doom S, De Waele J, Delrue LJ, Defreyne L, Benoit DD, Decruyenaere J (2011) Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis. Intensive Care Med 37:1921–1931PubMedCrossRefGoogle Scholar
  15. 15.
    Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, Metnitz PG (2009) Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 35:1692–1702PubMedCrossRefGoogle Scholar

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

Personalised recommendations