Pericardiocentesis

Faisal A. Al-Moaiqel

Pericardiocentesis

Objectives:DefinitionPathologyEtiologyProcedureComplications

What is Pericardiocentesis ?

Pericardiocentesis is a therapeutic and diagnostic procedure in which fluid is removed from the pericardium, the sac that surrounds the heart.

removal of 5 – 10 ml may increase stroke volume by 25 – 50%

PathologyCardiac Tamponade:

it is an accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise.

Symptoms:- Muffled heart sound- JVD- Hypotensionaccording to Beck's triad.

This anteroposterior-view chest radiograph shows a massive, bottle-shaped heart and conspicuous absence of pulmonary vascular congestion.

Etiology

For all patients, malignant diseases are the most common cause of pericardial tamponade. Among etiologies for tamponade, the most reported incidence rates:

● Malignant diseases● Idiopathic pericarditis● Infectious diseases● Anticoagulation

Tamponade can occur as a result of any type of pericarditis. Pericarditis can result from the following :

● Human immunodeficiency virus (HIV) infection● Infection - Viral, bacterial (tuberculosis), fungal● Drugs - Hydralazine, procainamide, isoniazid, minoxidil● Trauma to the chest● Radiation therapy to the chest● Hypothyroidism

ProcedurePrior to procedure:

Use echocardiogram or ultrasound to identify that fluid is moderately large and free of coagulation or loculation

Patients who are receiving anticoagulants will have these medications discontinued prior to the procedure.

We might need to raise the blood pressure until the pericardiocentesis can be performed.

ProcedureDescription of the procedure:

procedure is done under imaging guidance.1. Patient placed on supine position.2. The skin is sterilized and local anesthetic given.3. Use 3 inch, 16-20 ga. needle.

4. Identify the anatomic landmarks (xiphoid process, 5th and 6th ribs, shown below) and select a site for needle insertion. The most commonly used sites are the left sternocostal margin or the subxiphoid approach.Insert the needle immediately at a 30-45 degree angle. Direct the needle toward the left shoulder

5. Aspirate during insertion. Once fluid is encountered, stop advancing the needle and continue aspirating.

6. Leave the needle in the place, and secure it.

7. Reassess for improvement, repeated when it is necessary

After the procedure

The tube is left connected to the drainage bottle until there is no more fluid drained and no accumulation of fluid in the pericardium.Echocardiogram will be performed to monitor the clearance of fluid.

After a pericardial drainage procedure, monitor blood pressure and pulse and the neck veins will be examined for bulging.

The fluid should be tested for any identification of the cause.

Risk and Complication

● cardiac arrest● myocardial infarction or heart attack.● abnormal heart rhythms.● laceration of the heart muscle.● puncture of coronary arteries.● laceration of organs.● Hemothorax, pneumothorax and

pneumopericardium.

Tips

● Pericardiocentesis is for patient in cardiac arrest or susceptible cardiac tamponade. if pre arrest or arrest didn't work, that's assist diagnosis of cardiac tamponade.

● Pericardial tamponade often results in sudden cardiac arrest, so be prepared to immediately apply this therapy when indicated.

● This procedure is relatively common in cardiac arrest with PEA as a last resort attempt at resuscitation.

References:http://emedicine.medscape.com/article/152083-overview

http://www.healthline.com/galecontent/pericardiocentesis

http://emedicine.medscape.com/article/80602-overview

Thanks :-)