pericardiocentesis

see also:

• cardiac tamponade
• LITFL - pericardiocentesis

• therapeutic pericardiocentesis is an emergency procedure to prevent death in a patient with suspected cardiac tamponade
• diagnostic pericardiocentesis is often used to elicit the cause of patient with pericarditis with an effusion which is not settling with non-steroidal anti-inflammatory drugs (NSAIDs)

• aseptic technique if possible
• identify landmarks:
  • left paraxiphoid (traditional)
  • left parasternal (4th intercostal space left parasternal)
• for a left paraxiphoid approach:
  • 45 deg to the abdominal wall, head for the left shoulder, aspirate as you go
  • optionally attach a V lead to the base of the needle and watch ECG to look for a change in the QRS morphology, or ST elevation which indicates the needle has contacted the myocardium
  • aspirate fluid/blood
  • consider placing a catheter/pigtail
• NB. blood stained pericardial fluid will not clot whereas intraventricular blood will