Evaluation of different paediatric venous cannulae using gravity drainage and VAVD: an in vitro study

Abstract

Six different commercially available paediatric venous cannulae, together with a specially constructed cannula, were tested in vitro for their pressure-flow relationship. With the cannulae placed in an open reservoir, flow increased with larger diameters and higher pressures. At a pressure of 30 cm H2O, flows were 219 +/- 20, 285 +/- 13, 422 +/- 11 and 728 +/- 4 ml/min for the 12, 13.2, 14 and 16 French, respectively. No differences were found between angled and straight cannulae. When the cannulae were tested in a latex model simulating the right atrium and vena cavae, the highest flow obtained by gravity was 164 ml/min using an angled 14-French cannula. When vacuum was applied to augment venous return, a maximum flow of 179 ml/min was measured using an angled 14-French cannula. Collapse can occur when the pressure difference becomes too high in the test system. This is important, since most children are selectively cannulated in both major veins. Monitoring of the intravascular pressure might help to prevent collapse. A larger-diameter venous cannula does not always produce the highest flow when placed in a vein. This is most obvious when augmenting venous return. The design of the cannula tip, in combination with VAVD, can affect the venous return.

Cardiopulmonary bypass in the immature fetus through novel use of a mini-centrifugal pump

“…VAVR is becoming a widely accepted means for improvement of venous drainage while downsizing venous cannula size. 26 This may be a good solution to the problems we encountered with inadequate venous drainage. The lack of adequate preload probably contributed to the excessively high RPMs while on CPB.…”

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“…According to Galetti, this ratio should be around 0.5 in order to avoid collapse of the vein around the side holes of the cannula 7 . However, not only the diameter ratio is important, but also the design of the cannula and cannula tip 12 .…”