Cannulation is a potentially complex event in the conduct of venovenous extracorporeal membrane oxygenation (VV-ECMO) for patients with severe respiratory failure. The purpose of this article is to describe our approach to cannulation and its complications. A single-center, retrospective, observational cohort, electronic note review study of patients commenced on VV-ECMO for severe respiratory failure. We identified 348 cannulae placed in 179 patients commenced on VV-ECMO from December 2011 to March 2015. All cannulations were successful. There were no deaths related to cannulation, and complications included one arterial injury, one cardiac tamponade, two cases of venous insufficiency, and five cannula site infections. Percutaneous cannulation for VV-ECMO can be achieved with a high degree of success and low complication rate by intensivists using ultrasound and fluoroscopic guidance.