Pericardiocentesis

Reviewed and revised 4 May 2014

OVERVIEW

  • procedure used to remove pericardial effusion by needle aspiration

USES

  • treatment of pericardial effusion and/or tamponade

DESCRIPTION

Pericardiocentesis

METHOD OF INSERTION

  • subxiphoid approach
  • long 18-22 G needle attached to syringe
  • insertion: between xiphisternum and left costal margin
  • direct towards the left shoulder at 40 degree angle to skin
  • continual aspiration as needle approaches RV
  • once pericardial fluid aspirated, can insert cannula into pericardial space
  • attach a 3 way tap and remove fluid with improvement in haemodynamics

OTHER INFORMATION

  • pericardial blood doesn’t clot
  • intracardiac blood does clot
  • an ECG chest lead can be attached to the needle: ST elevation or ventricular ectopics signal contact with ventricle

COMPLICATIONS

  • myocardial perforation
  • bleeding
  • pneumothorax
  • arrhythmia
  • acute pulmonary edema (due to rapid drainage of pericardial fluid leading to excessive LV preload)
  • acute ventricular dilatation

REFERENCES

CCC 700 6

Critical Care

Compendium

…more CCC

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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