Pericardiocentesis

Indications==

-Cardiac Tamponade

-Diagnose etiology of pericardial effusion

Contraindications==

-Unstable: none

-Stable: coagulopathy, 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

-Coronary Artery Injury

-Hemo/PTX

-LIMA injury

-Reaccumulation

-False neg (clotted pericardial blood)

-False pos (intracardiac)