Pericardiocentesis

Indications

• Cardiac Tamponade
• Diagnose etiology of pericardial effusion

Contraindications

• Unstable: none
• Stable:
  • Cagulopathy
  • Traumatic tamponade
  • S/p CABG
  • Effusion <200cc
  • Overlying cellulitis

Equipment

• Pericardiocentesis kit

Prep

• 30-45˚ or supine
• NGT (decompress stomach)
• Subxiphoid prep
• Consider atropine

Technique

• 1cm inf, 1cm lat to subxiphoid
• 35cc syringe attached to 18g spinal needle
• attach V1 to needle base or use US
• 11 blade incision
  • 45˚ to abdomen, 45˚ to midline pointed towards L shoulder
• Insert and w/d until flash - stop if STE, cardiac pulsations

• NB: Pericardial blood won't clot, intracadiac blood will

• Can place 3-way stopcock
• Use seldinger to place indwelling cath if necessary

• Post CXR

Labs

• Hct, cell count, Cx/grm stain, cytology

Complications

• Arrhythmia
• Ventric free wall rupture
• Coronary artery injury
• Hemo/PTX
• LIMA injury
• Reaccumulation
• False neg (clotted pericardial blood)
• False pos (intracardiac)