Correct placement of the Avalon Elite Bicaval Dual Lumen catheter (Avalon Laboratories, LLC, CA) for single-site venovenous extracorporeal membrane oxygenation (VV ECMO) is safe using image guidance. Using this technique, 26 of 27 patients (96%) had uneventful placement of the cannula in the right internal jugular vein. One patient had a superior vena cava injury during serial dilation, and another patient required cannula repositioning for improved flows. We recommend using both fluoroscopy and transesophageal echocardiogram (TEE) for training purposes or during initial use of the Avalon Elite. As proficiency improves, TEE at the bedside provides an excellent standard of care. Double-lumen ECMO catheters can be effectively placed under image guidance with minimal need for repositioning.