Insertion and management of percutaneous veno‐venous bypass cannula for liver transplantation: a reference for transplant anesthesiologists

Abstract

Surgical advances using the retrohepatic caval preservation technique in liver transplantation (LT) has significantly decreased the need for veno-venous bypass (VVB). However, VVB still remains a viable adjunct of LT. The venous return cannula has traditionally been inserted using a cut-down technique via the axillary vein, but this technique carries significant risks for lymphorrhea, infection, or nerve damage. Since 2001, our institution has routinely used VVB in adult LT surgery. Percutaneous insertion of an internal jugular venous return cannula is performed by the attending anesthesiologist. The aim of this report is to describe the method of insertion and management of a percutaneous veno-venous return cannula in the internal jugular vein during LT. In-depth detail as well as video clips will provide a reference for LT centers wishing to apply this method in their practice.

Accidental insertion of a percutaneous venovenous cannula into the persistent left superior vena cava of a patient undergoing liver transplantation

“…13 Furthermore, the placement of the VVB cannula should be confirmed either by direct TEE visualization of the VVB cannula tip or by performing a ''bubble test'' through the VVB cannula. 2 The latter test would have demonstrated the immediate appearance of bubbles in the right atrium via the coronary sinus instead of via the superior vena cava and ultimately would have led to the diagnosis of a malpositioned cannula in the PLSVC. In this particular case, we acknowledge that we could have prevented the malposition of the cannula in the PLSVC by placement of TEE prior to the line exchange via the left IJV and identification of the guidewire in the superior vena cava throughout the VVB cannula placement.…”

“…Standard practice in this institution was to place a percutaneous VVB return cannula for LT cases. 2 Given the potential difficulty of inserting the return cannula via the right IJV in the presence of the tunnelled dialysis catheter, the cannula was placed via the left IJV. An 18 Fr.…”

Clinical applicability of rapid thrombelastography and functional fibrinogen thrombelastography to adult liver transplantation

“…During the study period, percutaneous venovenous bypass was used only for living donor LT. The anesthetic management was previously described in detail . Briefly, packed red blood cells were administered to maintain a hematocrit of 26% to 30%.…”

Operative Risks of Domino Liver Transplantation for the Familial Amyloid Polyneuropathy Liver Donor and Recipient: A Double Analysis

“…(3) Evaluation of the hemodynamic and splanchnic tolerance by clamping the portal pedicle and the inferior vena cava followed in some cases (patients who do not tolerate the clamping) by installation of extracorporal veno-venous bypass. Otherwise, for patients with symptomatic cardiac disease and pace makers, the extracorporal veno-venous bypass is installed systematically (25,26). (4) Completion of the total hepatectomy safely and rapidly.…”