Table 10. Strategies for venous cannulation.

Staged bicaval cannulation	Direct bicaval cannulation
Method of cannulation for sick hearts or difficult anatomy (when exposure of IVC can lead to severe hypotension)	Method of cannulation for most patients
RA and SVC are cannulated first followed by shift of RA cannula to IVC	SVC cannulation is followed by cannulation of IVC or vice versa*

*, some surgeons institute CPB with just IVC cannula before establishing flow through SVC cannula. Achievement of at least half flows through the IVC cannula alone rules out selective cannulation of a hepatic vein. CPB, cardiopulmonary bypass; IVC, inferior vena cava; SVC, superior vena cava.