FIELD: medicine.
SUBSTANCE: during femoral vein cannulation for veno-arterial extracorporal membrane oxygenation (VA ECMO), transcutaneous puncture of the femoral vein in the femoral triangle is performed under ultrasound and/or radiographic supervision. The femoral vein is catheterized with a single-lumen catheter with an outer diameter of 16G. A conductor is then inserted through the installed catheter to install the cannula. Along the conductor, dilators are subsequently introduced, expanding the channel in the subcutaneous adipose tissue and the puncture hole in the vascular wall. First, vascular dilators with an external diameter of 12-18F are introduced, and then a dilator in the form of a truncated cone ("cone" dilator), having rectilinear and arc-shaped parts. The arc-shaped part has a radius of curvature of 45-55 mm, the length of 110-120 mm, and is located on the side of the pointed end of the dilator. The outer diameter of the "cone" dilator in the region of the rectilinear and arc-shaped parts connection is 12-14 mm, and in the region of the pointed end - 3-5 mm. Introduction of the "cone" dilator is carried out in antegrade direction. It is positioned so that when passing under the fallopian ligament, the concave side of the arc-shaped part is turned away from the skin surface. After removal of the "cone" dilator, a cannula with an outer diameter of 23 mm is placed in the lumen of the femoral vein in the antegrade direction, 25F and attached to the venous VA ECMO.
EFFECT: method allows to reduce traumatism, simplify and improve the reliability of femoral vein cannulation for venous arterial extracorporeal membrane oxygenation.
1 dwg,1 ex
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Authors
Dates
2017-12-12—Published
2017-03-17—Filed