The Avalon Elite dual lumen cannula (Avalon Laboratories, Rancho Dominguez, CA) was developed as a means of single-site cannulation for veno-venous extracorporeal membrane oxygenation in patients with severe refractory respiratory failure. This cannulation strategy has several advantages over conventional strategies, however, is not without complication. We describe a case of right internal jugular vein "on a stick" (avulsion) after cannulation with the Avalon Elite cannula, and corroborate the critical importance of imaging guidance when using this system.
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