Pericardiocentesis

Indications

1. Cardiac Tamponade
2. Diagnose etiology of pericardial effusion

Contraindications

1. Unstable: none
2. Stable:
   1. Cagulopathy
   2. Traumatic tamponade
   3. S/p CABG
   4. Effusion <200cc
   5. Overlying cellulitis

Equipment

1. Pericardiocentesis kit

Prep

1. 30-45˚ or supine
2. NGT (decompress stomach)
3. Subxiphoid prep
4. Consider atropine

Technique

1. 1cm inf, 1cm lat to subxiphoid
2. 35cc syringe attached to 18g spinal needle
3. attach V1 to needle base or use US
4. 11 blade incision
   1. 45˚ to abdomen, 45˚ to midline pointed towards L shoulder
5. Insert and w/d until flash - stop if STE, cardiac pulsations
6. Can place 3-way stopcock
7. Use seldinger to place indwelling cath if necessary
8. Post CXR

Diagnosis

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

Labs

1. Hct
2. cell count
3. Cx/grm stain
4. cytology

Complications

1. Arrhythmia
2. Ventric free wall rupture
3. Coronary artery injury
4. Hemo/PTX
5. LIMA injury
6. Reaccumulation
7. False neg (clotted pericardial blood)
8. False pos (intracardiac)