[[300 Technical Outline of Coronary Artery Bypass Grafting]] [[700 Technical Outline of Repair of Aortic Dissection]] - Assistant holds venous cannula with stylet in right hand, grasps tip of atrial appendage with regular DeBakey forceps in left hand, and gently retracts the tip towards the left side of the table - Surgeon grasps free wall of the right atrial appendage at about the level of the most inferior cannulation stitch with regular DeBakey forceps in left hand, incises free wall close to the tip with Metzenbaum scissors in right hand. - Hole should be just big enough to admit venous cannula - Incise any trabeculations that interfere with passage of cannula - Close hole with left hand DeBakey if assistant needs more time to handle cannula, otherwise, keep grasp of tissue until cannula is in position - Assistant directs tip towards IVC, slides cannula in to the depth of "double line" mark - Some IVC can take an odd angle - Sometimes Eustachian valve can interfere - Surgeon cinches up cannulation stitch in Rumel, hands to assistant - Assistant pulls up slightly on Rumel, keeps venous cannula in place while surgeon encircles both with zero-silk tie-on-a-pass and a regular DeBakey, then ties both together, slightly indenting red rubber Robinson. - Assistant cuts knot as short as possible. - Steps are similar with redo-right atrium cannulation, except incision is made with 15-blade scalpel, inserted into right atrial free wall, inside of cannulation stitch, but towards base of stitch, sharp end of the blade directed towards the tip where the cannulation stitch ends emerge, possible augmentation of hole with spread tonsil clamp.