pericardiocentesis

introduction

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