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

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

Critical Care

Compendium

…more CCC

Chris Nickson

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

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

On Twitter, he is @precordialthump.

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