Pericardiocentesis: Difference between revisions
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*Hct, cell count, Cx/grm stain, cytology | *Hct, cell count, Cx/grm stain, cytology | ||
==Complications | ==Complications== | ||
*Arrhythmia | *Arrhythmia | ||
*Ventric free wall rupture | *Ventric free wall rupture |
Revision as of 03:55, 20 May 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)