title: Right ventricular loop indicating malposition of J-wire introducer for double lumen bicaval venovenous extracorporeal membrane oxygenation (VV ECMO) cannula.
abstract: The key to safe placement of a bicaval double lumen cannula for Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) is to visualise correct guide wire placement in the inferior vena cava (IVC), thus aiding subsequent correct advancement of the cannula. Transoesophageal (TOE) and transthoracic (TTE) echocardiography, as well as fluoroscopy, have been described as aiding imaging techniques. We report a case of guide wire malposition into the right ventricle, despite echocardiographic confirmation of guide wire position deep into the IVC. This malposition, if undetected, may have resulted in potential life threatening complications.
authors.affiliation: Department of Intensive Care Medicine, St. George Hospital, Conjoint Associate Professor UNSW, Australia. Electronic address: syastrebov@y7mail.com.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Yastrebov
authors.affiliation: Department of Cardiothoracic Surgery, St. George Hospital, Clinical Associate Professor, Graduate School of Medicine, University of Wollongong, NSW, Australia.
authors.forename: Con
authors.initials: C
authors.lastname: Manganas
authors.affiliation: Department of Intensive Care Medicine, St. George Hospital, Australia.
authors.forename: Tejo
authors.initials: T
authors.lastname: Kapalli
authors.affiliation: Department of Cardiothoracic Surgery, St. George Hospital, Australia.
authors.forename: Sheen
authors.initials: S
authors.lastname: Peeceeyen
mesh_terms: D000328:Adult; D057785:Catheters / Q000009:adverse effects*; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D014682:Vena Cava, Inferior
keywords: Bicaval double lumen ‘Avalon’ cannula; Malposition; Transoesophageal and transthoracic echocardiography; Venovenous Extracorporeal Membrane Oxygenation