The cannulas are secured with 2-0 silk sutures to the skin overlying the
mastoid process. A chest x-ray is used to confirm position after placement
of the cannulas; echocardiography may also be employed to identify the
correct position of the cannulas within the great vessels. Care is taken to
ensure that hemostasis is obtained and the skin is closed with a
continuous 4-0 nylon suture.Figure 2. A schematic of VA cannulation in a neonate; the vantage point is at the head of
the bed.
Percutaneous access to the internal jugular and femoral vein is the
preferred approach to cannulation in adults and children over 3 years of age.[ 3 ]
Sequentially larger dilators are placed over a wire using a Seldinger technique.
A variety of cannulas are available for percutaneous venous and arterial access
to provide ECLS. The cannulas have varied abilities for gas exchange and flow