Pericardiocentesis: Difference between revisions

Revision as of 21:50, 9 April 2011

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)

Authors:

@@ Line 1: / Line 1: @@
-Indications==
+==Indications==
+*Cardiac Tamponade
+*Diagnose etiology of pericardial effusion
+==Contraindications==
+*Unstable: none
+*Stable:
+**Cagulopathy
+**Traumatic tamponade
+**S/p CABG
+**Effusion <200cc
+**Overlying cellulitis
--Cardiac Tamponade
+==Equipment==
+*Pericardiocentesis kit
--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
+==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
-Technique==
+*NB: Pericardial blood won't clot, intracadiac blood will
--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)
+*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)
 [[Category:Procedures]]