Pericardiocentesis Procedure

Indications

■ Cardiac tamponade
■ ⁄ pericardial effusion † ø hemodynamics
Contraindications
■ Coagulopathy/bleeding dysfunction
■ Skin infection over needle insertion site
Equipment
■ Skin preparation supplies, sterile gloves, towels/drapes
■ Local anesthetic (1% or 2% lidocaine, 25-G needle, 3-mL syringe)
■ Pulse oximeter, ECG monitoring (V lead)
■ 16- to 18-G spinal needle and No. 11 blade
■ 20-mL syringe and sample tubes

Preparation

■ Continuous ECG monitoring (30° semi-Fowler position preferred); if V lead attached to pericardiocentesis needle † ⁄ sensitivity; an insulated wire with alligator clips at each end works well
■ Prepare skin; sterile technique; wear sterile gloves, mask, and gown; drape over xiphoid area
■ Local anesthesia (infiltrate skin 1%-2% lidocaine)

Patient Positioning

■ Supine with thorax (i.e., head of bed) elevated 30-45 degrees

Technique

■ Needle: Insert (2 cm below costal margin to left adjacent to xiphoid with blade) and direct (upward and posterior) at 45-degree angle for 4-5 cm; aim toward right (preferable) or left (⁄risk penetrate RV) scapular tip
■ Advance (aspirate continuously) needle until encounter fluid, check for cardiac pulsations, or ⁄ST on ECG. May feel needle enter cavity
■ Remove blood: (usu. 5-10 mL because most is clotted); if 20 mL, then probably in RV
■ If hemodynamics do not improve, then may need thoracotomy or local pericardial window excision
■ Send fluid for appropriate studies

Complications

Myocardial wall injury/penetration, myocardial infarction, pneumothorax, bowel perforation

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