3. Instrument
Holder panel
Soft tissue
and or MICS
retractor
Surgeon
Position
1st
Assistant
Pump
Left groin cannulation
preferredSurgical
Tech.
Variations exist depending upon procedure,
body habitus and surgeon/anesthesia
experience.
MICS OPERATING ROOM
TEE
Anesthetist
Position
4. Current Cannulation Strategies
Favours CENTRAL AORTIC rather than FEMORAL ARTERIAL
Percutaneous Femoral Dual stage Venous Cannulation over
Neck Acess
Transaxillary/ Transthoracic Clamping over Endo Clamp
resulting in low complication rates and a reliable
platform for a variety of MICS procedures
8. VENOUS CANNULATION STRATEGIES
• Percutenous Femoral Venous Cannulation
• Direct SVC Cannulation , percutenaous and
under vision
– Special way of holding SVC canula with a right angled forcep
practiced in our centre for SVC cannulation under vision.
– Advantage being no need of TEE for confirmation of position
– Return can be checked instantly and cannula position altered.
• Direct RA Cannulation (in Ministernotomy)
– Not widely mentioned but very sucessfullypracticed in our
centre
9. Peripheral Cannulation - SCHEMATIC
1. SHORT OBLIQUE INCISION
2. LOPP FEMORAL ARTERY (NOT VEIN)
3. PURSE STRING SUTURES
4. STAY SUTURE (OPTIONAL)
5. PROPOFOL ( AS A LUBRICANT) – OPTONAL
6. INCISE THE VEIN VERTICALLY – FOR BETTER REPAIR
Hegar reduces bleeding ,facilitates mild dilation
7. GRADUALLY ADVANCE THE CANULA WITH THE GUIDEWIRE FIXED WITH DRAPE SHEET (may withdraw
wire off and on for better slide and no kink)
8. TEE CONFIRMATION OF TIP AT RA
9. NOW CANULA CAREFULLY PPLACED AT SVC – RA JUNCTION
It will preferentially enter the RA appendage and roll. So guidewire readvanced with the nose
tip appropriately placed to facilitate entry into the SVC. Once in the SVC nose is advanced slowly
with TEE confirmation once position confirmed the the remains bit is done by advancing the
cannula over the stiletto itself to prevent injury at the junction
15. Direct RA Venous Canula
Has malleable
stylet which aids in
direct atrial
cannulation and the
wire reinforcement
allows for a
drainage even with
vaccum assisted
drainage
16. SMOOTHER INLET TIP AND WIDE SIDE HOLES
BOTH FEMORAL AND JUGULAR ACCESS
WITH SAME CANULA
Easy to insert
Versatile
ADVANTAGES OF NEWER GENERATION CANNULAE
17. Newer Generation Canulae – performance
upgrades
• Shorter clamp site eases tubing management
• New radiopaque suture ring
• Thin-wall design promotes maximum flow rates
• Flexible and kink resistant.
• Stainless steel wire-winding and reinforced walls
18.
19. Triple staged Canula
These Cannulae have 3
ports which accounts for
better drainage and
lower pressure drop
across the canula
accounting for better
hemodynamics .