The advantages of a dual-lumen jugular vein extracorporeal membrane oxygenation (ECMO) catheter include single vessel placement, minimal recirculation and the potential for early patient mobilization. Despite all these advantages, its application remains limited by the large cannula size and more importantly, the sophisticated imaging techniques required to ensure safe cannulation and to guide optimal catheter depth and positioning. Despite the various reports on the successful dual-lumen ECMO

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... atheter insertion by transesophageal echocardiography (TEE) guidance alone, some potential complications are not perfectly avoidable. While TEE remains a paramount guidance especially during emergency bedside cannulation, we would like to discuss our method of fluoroscopic guided dual-lumen catheter insertion, which can give addition information on top of TEE guidance: to allow safe insertion of stiff wire for better supported Seldinger's technique; and for proper guidance of depth and positioning during catheter insertion. If situation allows, the routine use of fluoroscopy during dual-lumen ECMO catheter insertion should be re-emphasized. In this article, our step-by step approach of fluoroscopy guided dual-lumen ECMO catheter insertion is illustrated, with particular focuses on the exchange to stiff guidewire and the use of another guidewire to mark to return port, which allow safe and accurate positioning of the ECMO catheter.