Percutaneous Femoral Venous Cannulation—How to Do It

Percutaneous femoral venous cannulation is an essential skill for cardiac surgeons, particularly useful prior to redo sternotomy, minimal access valve surgery, ECMO, and for venous drainage during open thoracoabdominal aneurysm repairs. This technique avoids the need for surgical cutdown and reduces the associated groin complications, such as infection or lymphocele. 
  
It is crucial to follow certain steps to avoid technique-related complications, including right atrial and inferior vena cava (IVC) perforation, and poor drainage relating to suboptimal position of the cannula. In this narrated video, the authors describe the key technical steps for insertion of the cannula, starting with the groin anatomy and identification of vessels using ultrasound. Although many surgeons insert the venous cannula using the basic wire accompanying the cannula pack, the authors’ preference is to exchange this wire for an Amplatz super-stiff guidewire (over a Berenstein catheter). The key advantage of this additional step is that it allows visual confirmation of the catheter’s position in the superior vena cava (SVC) by injecting saline solution. Additionally, the stiff guidewire facilitates easier cannula insertion, especially in obese patients with challenging pelvic venous anatomy. 

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