Percutaneous bypass cannulae can interfere with rapid infusion during liver transplantation

Abstract

VENOVENOUS BYPASS (VVB) may be used during orthotopic liver transplantation (OLT) to maintain adequate preload when blood return to the heart is interrupted by cross-clamping of the inferior vena cava. Traditionally, when VVB is used, 1 drainage cannula is inserted via surgical cutdown into a femoral vein, and another is used to cannulate the portal vein directly. A centrifugal pump is used to aspirate venous blood from these sites and return it through a cannula inserted via surgical cutdown into an axillary vein. To avoid the complications of surgical cutdowns, percutaneous VVB has been used. 1 Tisone G Mercadante E Dauri M et al. Surgical versus percutaneous technique for veno-venous bypass during orthotopic liver transplantation: A prospective randomized study. Transplant Proc. 1999; 31: 3162-3163 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 2 Frenette L Cox J Singer D et al. Five years of experience with percutaneous cannula for establishing venous bypass access in orthotopic liver transplantation. Transplant Proc. 1996; 28: 2974-2977 PubMed Google Scholar , 3 Manas DM Gibbs P Talbot D et al. Use of percutaneously placed catheters for venovenous bypass in orthotopic liver transplantation. Transplantation. 1996; 62: 144-145 Crossref PubMed Scopus (3) Google Scholar , 4 Spiekermann BF Bogdonoff DL Hershey JE McLaughlin JD A method for percutaneous cannulation for veno-veno bypass during orthotopic liver transplantation. Anesth Analg. 1995; 80: 432-433 PubMed Google Scholar , 5 Scherer R Erhard J Giebler R et al. Percutaneous portofemoro-subclavian venovenous bypass during orthotopic liver transplantation. Transplantation. 1994; 57: 472-473 Crossref PubMed Google Scholar , 6 Scherer R Giebler R Schmutzler M et al. Effect of high shunt flows during portofemoro-subclavian venovenous bypass in human orthotopic liver transplantation. Transplant Proc. 1993; 25: 2591 PubMed Google Scholar , 7 Washburn WK Lewis WD Jenkins RL Percutaneous venovenous bypass in orthotopic liver transplantation. Liver Transpl Surg. 1995; 1: 377-382 Crossref PubMed Scopus (9) Google Scholar , 8 Ozaki CR Langnas AN Bynon JS et al. A percutaneous method for venovenous bypass in liver transplantation. Transplantation. 1994; 57: 472-473 Crossref PubMed Google Scholar , 9 Scherer R Giebler R Erhard J et al. A new method of veno-venous bypass during human orthotopic liver transplantation. Anaesthesia. 1994; 49: 398-402 Crossref PubMed Scopus (15) Google Scholar , 10 Johnson SR Marterre WF Alonso MH Hanto DW A percutaneous technique for venovenous bypass in orthotopic cadaver liver transplantation and comparison with the open technique. Liver Transpl Surg. 1996; 2: 354-361 Crossref PubMed Scopus (16) Google Scholar Although these reports all use at least 1 percutaneous cannula in the VVB circuit, they vary in their choice of cannulation sites, types and sizes of percutaneous cannulae, and VVB circuit configuration. The authors' VVB technique also varies from what has been reported. The authors routinely insert percutaneously a left femoral venous drainage cannula and a right internal jugular (RIJ) venous return cannula. The RIJ cannula serves a dual role as the major conduit for intravenous infusions from the rapid infusion system (RIS) (Haemonetics Corporation, Braintree, MA); this eliminates the need for additional large-bore intravenous access. In the following case, an unusually high VVB flow rate limited the maximal intravenous infusion rate of the RIS.