Pericardiocentesis, a procedure where they aspirate fluid from pericardiac sac.

1. Pericardiocentesis
Faisal A. Al-Moaiqel

2. Objectives:
Definition
Pathology
Etiology
Procedure
Complications

3. 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%

4. Pathology
Cardiac 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
- Hypotension
according to Beck's triad.

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

6. 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

7. Procedure
Prior 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.

8. Procedure
Description 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.

9. 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

11. 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

12. 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.

13. 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.

14. 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.

15. References:
http://emedicine.medscape.com/article/152083-overview
http://www.healthline.com/galecontent/pericardiocentesis
http://emedicine.medscape.com/article/80602-overview

16. Thanks :-)