title: Migrated Avalon Veno-Venous Extracorporeal Membrane Oxygenation Cannula: How to Adjust Without Interruption of Flow.
abstract: The Avalon dual lumen cannula is presently the cannula of choice for veno-venous extracorporeal membrane oxygenation (VV-ECMO) via right internal jugular cannulation. This cannula establishes VV-ECMO with a single cannulation; however, it requires appropriate positioning to gain adequate oxygenation. Malposition of this cannula can cause inadequate ECMO flow, hypoxia, and structural injury. We have experienced two cases of migration: one into the hepatic vein and the other into the right ventricle. The former was repositioned using echocardiographic guidance without using a guidewire. The latter was repositioned using a guidewire from the femoral vein under fluoroscopy, without antegrade wire placement into the Avalon cannula, discontinuation of ECMO, or bleeding.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Daizo
authors.initials: D
authors.lastname: Tanaka
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Harrison T
authors.initials: HT
authors.lastname: Pitcher
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cavarocchi
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirose
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods*; D057785:Catheters / Q000009:adverse effects*; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D005268:Femoral Vein; D005471:Fluoroscopy; D005548:Foreign-Body Migration / Q000209:etiology* / Q000628:therapy*; D006352:Heart Ventricles; D006503:Hepatic Veins; D006801:Humans; D008297:Male; D014682:Vena Cava, Inferior; D055815:Young Adult