Semin cardiothorac vasc anesth

Venous Cannulation Considerations

The surgical procedure and strategy will also dictate the 

venous cannulation technique required. The options are 

outlined in Table 1. If an upper or lower hemisternotomy is 

performed, direct right atrial (RA), superior vena cava 

(SVC), or inferior vena cava (IVC) cannulation can be uti-

lized. If a right thoracotomy is performed, the right femo-

ral vein is commonly cannulated, and placement is guided 

via TEE. The femoral venous cannula can be advanced 

through the RA and into the SVC for bicaval single can-

nula drainage or can be placed at the junction of the IVC 

and RA for bicaval dual cannula drainage. SVC cannula-

tion can also be performed percutaneously using a modi-

fied Seldinger technique through the right internal jugular 

(RIJ) vein or a direct SVC cannulation through the thora-

cotomy. In addition to the obligatory indication for bicaval 

cannulation in RA procedures, for example, tricuspid valve 

repair or atrial septal defect repair, to facilitate adequate 

venous drainage, some groups routinely place a percutane-

ous RIJ cannula in patients who exceed a body weight of 

75 to 80 kg.

RIJ cannulation is most commonly performed with ultra-

sound guidance by the anesthesia team. Two guidewires are