Right ventricular loop indicating malposition of J-wire introducer for double lumen bicaval venovenous extracorporeal membrane oxygenation (VV ECMO) cannula

Heart Lung Circ. 2014 Jan;23(1):e4-7. doi: 10.1016/j.hlc.2013.05.643. Epub 2013 Jun 21.


The key to safe placement of a bicaval double lumen cannula for Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) is to visualise correct guide wire placement in the inferior vena cava (IVC), thus aiding subsequent correct advancement of the cannula. Transoesophageal (TOE) and transthoracic (TTE) echocardiography, as well as fluoroscopy, have been described as aiding imaging techniques. We report a case of guide wire malposition into the right ventricle, despite echocardiographic confirmation of guide wire position deep into the IVC. This malposition, if undetected, may have resulted in potential life threatening complications.

Keywords: Bicaval double lumen ‘Avalon’ cannula; Malposition; Transoesophageal and transthoracic echocardiography; Venovenous Extracorporeal Membrane Oxygenation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Catheters / adverse effects*
  • Echocardiography*
  • Echocardiography, Transesophageal*
  • Extracorporeal Membrane Oxygenation / adverse effects*
  • Humans
  • Male
  • Vena Cava, Inferior