title: Pressure-guided positioning of bicaval dual-lumen catheters for venovenous extracorporeal gas exchange.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: US Army Institute of Surgical Research, 3400 Rawley E. Chamber Avenue, Fort Sam Houston, San Antonio, TX 78234-6315, USA. thomas.langer@unimi.it
authors.forename: Thomas
authors.initials: T
authors.lastname: Langer
authors.forename: Vittoria
authors.initials: V
authors.lastname: Vecchi
authors.forename: Slava M
authors.initials: SM
authors.lastname: Belenkiy
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.forename: Andriy I
authors.initials: AI
authors.lastname: Batchinsky
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000379:methods*; D002405:Catheterization, Central Venous; D002407:Catheterization, Swan-Ganz; D057785:Catheters; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D007601:Jugular Veins; D012756:Sheep