P4A045: ECMO Cannula to Dialysis Catheter Exchange Using a Modified Seldinger Technique

Introduction: The Seldinger technique is the most common method used for central venous catheter placement. A frequently used alternative is the cutdown technique, although its use is limited to smaller pediatric patients. The necessity of catheter exchange is a regularly encountered challenge during the management of complex patients in the intensive care units. Specifically, exchanging cannulas of varying calibers can be particularly challenging, and successful exchange may be highly dependent on how central access was initially acquired. Here we report a novel application of the Seldinger technique to access a large caliber Extracorporeal Membranous Oxygenation (ECMO) cannula and allow easier exchange to a dialysis catheter.

Case Description: Performing a catheter exchange following an open procedure is simple as proximal and distal control is possible, as is exchange over a wire of a small caliber catheter. However, placing a wire through a large caliber ECMO cannula will result in a large amount of blood loss due to caliber differences. In this procedure, the 21 French ECMO cannula was kept in the vein and access to the venous system was obtained by inserting the finder needle through the cannula itself, allowing the cannula to act as the internal jugular vein for the catheter exchange. Through this needle we were able to advance a wire through the cannula to maintain venous access without any blood loss. The wire remained in the vein as the ECMO cannula was removed, and a dialysis catheter was placed over the wire with minimal blood loss.

Discussion: One patient at our institution underwent ECMO cannula to dialysis catheter exchange using this novel application of the Seldinger technique. Patient did not have any post operative complications regarding surgical site infection, hematoma, rebleeding, or rehospitalizations. Two weeks later, dialysis catheter was removed with no complications.

Conclusion: Based on our preliminary findings in this single patient case report, we propose this modified Seldinger technique to exchange an ECMO cannula for a dialysis catheter is a highly efficient and safe procedure to minimize blood loss while maintaining venous access that may lead to improved patient outcomes and more simple catheter exchanges.