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
   1. Removal of as little as 5-10 mL of blood may increase SV by 25-50%
   2. Stop if ST elevation, cardiac pulsations
   3. Pericardial blood won't clot, intracadiac blood will
6. Can place 3-way stopcock
7. Use seldinger to place indwelling cath if necessary
8. Post CXR

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)
   1. If 20mL of blood easily and rapidly withdrawn likely aspirating from RV

Source

Tintinalli