Confirming Distal Perfusion Catheter Position by Micro-bubbles in Patients on Peripheral Venoarterial Extracorporeal Membrane Oxygenation

Abstract

Distal perfusion catheter (DPC) is commonly employed to prevent lower limb ischemia in patient put on peripheral venoarterial extracorporeal membrane oxygenation. Confirming its proper position is important but technically difficult by bedside ultrasound. We describe in this article a novel method to use micro-bubble ultrasound enhancing agents, which are commonly used for contrast echocardiography studies, to confirm DPC position at the bedside. The sequential appearance of the micro-bubbles in the popliteal artery and then popliteal vein by ultrasound after injection through the side port of the DPC confirms the proper DPC position.

Methods for bedside assessment of venoarterial extracorporeal membrane oxygenation distal perfusion cannula positioning

“…While ultrasound visualization of sulfur hexafluoride microbubble ultrasound enhancing agent (SonoVue; Bracco) in the popliteal artery after injection through a DPC has been previously described, 4 we demonstrate that rapid injection of agitated saline alone provides adequate echogenicity to confirm DPC positioning. This confers several advantages, including lower cost, more ready availability, and no risk of intolerance reactions.…”

Bedside angiography of distal perfusion catheter for veno-arterial extracorporeal membrane oxygenation

“…Formal angiography or open placement can confirm placement of the distal perfusion cannula in the SFA, and ILE perfusion, however these may require fluoroscopic capabilities, and potentially add the morbidity of a groin incision, respectively. Previously described bedside methods to confirm placement in the SFA are with micro-bubble administration via the distal perfusion cannula visualized under ultrasound, 9 and the visualization of a guidewire passed through the distal perfusion cannula under ultrasound. 10 Another method to assess blood flow is via color-flow doppler ultrasonography down the ILE.…”

Enhanced vascular assessment by ultrasound using microbubble contrast after percutaneous decannulation of peripheral veno-arterial extracorporeal membrane oxygenation

“…Microbubble contrast was reported to be safely applied in patients on ECMO support. 7 While the readers would be keen to try on other potential areas of microbubble applications in patients on VA-ECMO, there is a potential risk of ECMO circuit cut-flow due to activation of bubble alarm when microbubbles are injected. 4 Apart from close monitoring by an ECMO specialist, complete destruction of microbubbles by ultrasound waves of high mechanical index is recommended after imaging assessment.…”