Pericardiocentesis

Question 1

Why do we do Pericardiocentesis? (2)

Answer 1

• Therapeutic
• Diagnostic

Question 2

How do you position for a Pericardiocentesis?

Answer 2

•Left lateral recumbence

–Avoid laceration of main coronary vessels

–The right side has a larger cardiac notch

•Between the 4th and 6th intercostal space at the level of the costochondral junction (elbow crosses the costochondral junction)

Question 3

What other therapies/monitoring must you use?

Answer 3

• Sedation
• Aggressive fluid
• ECG monitor

Question 4

What are the possible complications of Pericardiocentesis? (5)

Answer 4

–Cardiac puncture

–Arrhythmias

–Dissemination of infection or neoplasia

–Atrial fibrillation

–Myocardial stunning (systolic dysfunction post-drainage)

Question 5

How do you approach a Pericardiocentesis?

Answer 5

• ECG (?)
• Clip right thoracic wall and surgical prep
• Infiltrate LA at costochondral junction
• ICS 4-6
• Stab incision
• 5 inch catheter
• Advance until feel scratch / pop
• NB withdraw 2ml & check if clots!!!!!