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If inserting both the swan sheath and the venous drainage bypass cannula in the right internal jugular vein, insert both guidewires first ~2cm apart, then railroad the cannulae. This avoids accidental damage to the cannula inserted first, by the needle for the cannula inserted second.

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Ask surgeons where they will be placing arterial and venous cardiac bypass cannulae. They may ask you to place an internal jugular venous drainage cannula.

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Cannulae for cardiopulmonary bypass will be placed in either femoral artery and vein, or internal jugular vein plus the femoral artery and vein.

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If not using an internal jugular venous suction cannula, surgeon may advance the femoral venous cannula up into the superior vena cava.

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Large bore intravenous cannula prior to induction

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Deflate right lung prior to the surgeon commencing the thoracotomy to minimise injury to the lung

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Double lumen endotracheal tube DLT to isolate and deflate right lung.

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Aorta will be clamped with the clamp inserted either through the thoracotomy or an additional intercostal incision. Cardioplegia will be infused through an aortic cannula inserted through the thoracotomy.

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Place defibrillation pads prior to prepping/draping the patient.

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Left axilla and right posterior shoulder
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Surgical access will be via a right sided mini-thoracotomy under direct vision

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Considerations as for cardiac bypass

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Considerations as for cardiac surgery

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Considerations as for mitral stenosis or mitral regurgitation

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Semi supine position with the right side elevated ~15 degrees

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