Various current brands that are available and their theoretical advantages & disadvantages

Ascending Aorta

1. 3M Sarns

a) Description

i) Soft flow aortic cannula with flange, angled tip

ii) Smooth tapered reverse angle tip facilitates insertion & positioning

iii) Closed diffuser tip decreases velocity & distributes flow

iv) Large side vents allow for diffuse, high flow diffusion

v) OD 7 mm & 8mm (22 - 24 F)

b) Comments

i) Associated with reduced inlet pressures, turbulence, reduced jetting & subsequent trauma to aorta (sandblasting effect of high velocity jet of blood exiting the aortic cannula and impacting on the atherosclerotic intima or pedunculated atheroma)

ii) Approx half of patients with coronary artery disease have some degree of atheroma in the ascending aorta

2. Research medical

a) Description

i) Curved tip with suture flange

ii) Non reinforced, vent cap

iii) OD 22 F

b) Comments

i) Standard ascending aortic cannula used at RNSH

Descending Aorta

1. DLP Medtronic

a) Description

i) Descending arch cannula with introducer

ii) OD 21 F (24 F available)

b) Comments

i) High flow, low profile to provide easier access to the descending aortic arch

ii) Designed to provide easier access to the descending arch or femoral arteries

iii) Thin wall maximises flow & minimises pressure drop

iv) Radiopaque construction & depth markings facilitate visibility & positioning

v) Tapered dilator for use with a guidewire

Femoral Artery

1. Research Medical

a) Description

i) Short length

ii) OD 20 & 22 F

iii) Bevelled tip

b) Comments

2. Bard

a) Description

i) Short length

ii) OD 18 & 24 F

iii) Bevelled tip

iv) ± flange

b) Comments

3. Bard

a) Description

i) Medium length

ii) OD 18 F

iii) Distal lateral holes

b) Comments

i) Incorporated into Percutaneous insertion kit

ii) Cannula passed into distal descending aorta via femoral & iliac arteries

Venous [IVC; SVC; Atrial]

1. Research Medical

a) Description

i) Thin flexÔ Total lumen wire reinforced dual drainage venous return cannula with obturator, open light house tip

a) Light house tip yields superior flows to bullet tip

b) Thin flexÔ: patented very narrow wall thickness

ii) OD 36-46 Fr [32-40 also available]

b) Comments

i) Standard venous cannula used at RNSH

ii) Drains both IVC & RA

2. Research Medical

a) Description

i) Single venous return cannula

ii) Wire reinforced

iii) Open & bevelled right angled tip

iv) OD 28 Fr & 24 Fr

b) Comments

i) 24F inserted into SVC while 38 inserted into IVC

ii) These newer well designed cannula allow for adequate flows via smaller Fg OD

3. Medtronic

a) Description

i) Single stage venous cannula

ii) Wire reinforced

iii) Right angled metal & bevelled tip

iv) OD 24 F

b) Comments

i) 24F inserted into SVC while 38 inserted into IVC

ii) These newer well designed cannula allow for adequate flows via smaller Fg OD

4. Jostra

a) Description

i) Single stage venous cannula

ii) Wire reinforced

iii) Right angled lighthouse tip

iv) OD 32 F & 30 F

b) Comments

i) 30F inserted into SVC while 30F inserted into IVC

ii) These older designed cannula require larger Fg for adequate flows

5. Jostra

a) Description

i) Single stage venous cannula

ii) Wire reinforced

iii) Straight lighthouse tip

b) Comments

i) Straight design usually inserted into IVC while right angle into SVC

6. Polystan

a) Description

i) Single stage venous cannula

ii) Straight bullet tip

b) Comments

Venous [Femoral]

1. Medtronic Biomedicus DLP

a) Description

i) Venous femoral cannula

ii) OD 29F

iii) Thin wall polyurethane body

iv) Wire wound construction (ie the whole cannula is flexible & metal) to resist kinking & maintain patency yet offer sufficient flexibility for successful placement through tortuous vessels

v) Smooth tapered lumen + side ports to maximise flow rates

vi) Radiopaque with depth markers to facilitate insertion & positioning

vii) Available with Carmeda surface

viii) OD 23, 25, 17, 29 F

b) Comments

i) “. . . ideally suited for use in a technically difficult operation; transforms it into a less tedious, less time consuming, and dangerous than reopening a sternal-split operative site”

2. Medtronic Biomedicus DLP

a) Description

i) Percutaneous femoral venous cannula

ii) Wire wound construction (ie the whole cannula is flexible & metal)

iii) OD 21 F

b) Comments

3. Bard

a) Description

i) Percutaneous femoral venous cannula

ii) OD 18F

b) Comments

i) Part of a percutaneous femoral artery & vein cannulation kit

Types of cannula for: single atrial; bicaval; arterial; femoral; ECMO; VAD

a)single atrial

Manufacturer	Sizes	Special features	Important notes
SARNS	51F	Large flow(not two stage)	BSLT
SARNS	36F*51F 32F*40F	Two stage, PVC and polyethylene ,Wire reinforced, Available with distal short segment. Flow characteristics on info sheet	Used for CABGs Contra: open right heart chambers or septal defects. Some of the blood returning from the body may bathe the right heart and hence interfere with myocardial protection.

b) Bicaval

Manufacturer	Sizes	Special Features	Important notes
DLP	24F-28F	Metal tipped gives better ID:OD ratio	Better exposure in some cases.
BARD (William Harvey)	24F-34F	Wire reinforced, Straight	HTX, Open procedures, caval occlusion.

c) Arterial

Manufacturer	Sizes	Special Features	Important notes
BARD (William Harvey)		Has introducer to help cannulate calcified aortas, May have a ridge or no ridge distally.	AF uses. Contra : AORTIC medial necrosis, Marfans, calcified aortas dissections
SARNS	24F	PVC, polyethelene, Longer middle section than femoral. De-airs itself, depth ring	JM,PS uses

d) Femoral

Manufacturer	Sizes	Special Features	Important notes
BARD (William Harvey) Arterial	14F-22F	May have a ridge or no ridge distally.	Contra : Femoral Vessel size or vessel disease
BARD (William Harvey) Venous	24F-34F	Wire reinforced, Straight	Femoral vein

e) ECMO

ECMO: percutaneous; put in the largest cannula possible; 18-21 F

f) VAD

Manufacturer	Sizes	Special Features	Other
Biomedicus (arterial femoral percutaneous)	21F(arterial 29F(metal coiled )	percutaneous Has introducer

VAD: left atrial [standard right angled venous cannula up to 32 F] - femoral line

Relationship between French gauge & mm

French gauge	Tip OD
8	2.7
10	3.3
12	4.0
14	4.7
16	5.2
18	6.0
20	6.7
22	7.3
24	8.0
28	9.3
30	10.0
40	13.3

· 1 French gauge [Fr] = 0.33 mm OD

· Note 9 Fr = 12 ga

Methods of determining flow through cannulae. Know how to use test results & graphs to determine the optimum cannula

· Goal is to select the narrowest bore cannula that will tolerate the expected flows with out causing excessive turbulence etc

· M number