What is Pericardiocentesis ?Pericardiocentesis is atherapeutic and diagnosticprocedure in which fluid isremoved from thepericardium, the sac thatsurrounds the heart.removal of 5 – 10 ml mayincrease stroke volume by25 – 50%
PathologyCardiac Tamponade: it is an accumulation offluid in the pericardial space,resulting in reducedventricular filling andsubsequent hemodynamiccompromise.Symptoms:- Muffled heart sound- JVD- Hypotensionaccording to Becks triad.
This anteroposterior-view chest radiograph shows a massive, bottle-shaped heart and conspicuous absence of pulmonary vascular congestion.
EtiologyFor all patients, malignant diseases are the most common cause ofpericardial tamponade. Among etiologies for tamponade, the mostreported incidence rates: ● Malignant diseases ● Idiopathic pericarditis ● Infectious diseases ● AnticoagulationTamponade can occur as a result of any type of pericarditis. Pericarditiscan 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 identifythat fluid is moderately large and free ofcoagulation or loculation Patients who are receiving anticoagulantswill have these medications discontinued priorto the procedure. We might need to raise the blood pressureuntil 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 anestheticgiven.3. Use 3 inch, 16-20 ga. needle.
4. Identify the anatomiclandmarks (xiphoid process,5th and 6th ribs, shownbelow) and select a site forneedle insertion. The mostcommonly used sites are theleft sternocostal margin orthe subxiphoid approach.Insert the needleimmediately at a 30-45degree angle. Direct theneedle toward the leftshoulder
5. Aspirate during insertion.Once fluid is encountered,stop advancing the needleand continue aspirating.6. Leave the needle in theplace, and secure it.7. Reassess for improvement,repeated when it is necessary
After the procedureThe tube is left connected to the drainage bottle until there isno more fluid drained and no accumulation of fluid in thepericardium.Echocardiogram will be performed to monitor the clearanceof fluid.After a pericardial drainage procedure, monitor bloodpressure and pulse and the neck veins will be examined forbulging.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 didnt work, thats 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.