PERICARDIOCENTESIS

REASONS FOR VISIT

• Cardiac tamponade

• Infection

• Pericardial effusion

• Idiopathic

• Infectious

o Bacteria / Viral /Fungal /Rickettsial organisms

/Parasitic

• Neoplasm

o Metastatic

o Primary

• Early and late post-MI,

• Rupture of ventricular aneurysm

• Rupture of dissecting aortic aneurysm

• Autoimmune disorders

o Systemic lupus erythematosus (SLE)

o Rheumatoid arthritis (RA)

o Scleroderma

o Polyarteritis nodosa (PAN)

o Temporal arteritis

o Mixed connective tissue disorder (MCTD)

o Inflammatory bowel diseases (IBD)

o Sarcoidosis

o Behçet disease
 o Myasthenia gravis

• Trauma

o Blunt

o Penetrating

o Iatrogenic

• Hypothyroidism

• Amyloidosis

• Chylopericardium

• Uremia

• Radiation

• Pneumopericardium

• Postcardiothoracic surgery

• Idiopathic thrombocytopenic purpura

• Postpericardiotomy syndrome

• Biochemical, cytologic, bacteriologic, and immunologic

analysis

• Assessment of hemodynamics after pericardial pressure

has been lowered to exclude effusive constrictive
pericarditis

ADDNEW

RISK ASSESSMENT
•Myocardial rupture

•Aortic dissection

•Skin infection at site

•Severe bleeding disorder

•History of allergies to
 1Medicines
2Anesthesia

ADDNEW

PREPARATION OF THE PATIENT

• Blood tests
• Urine analysis
• Prothrombin time
• Activated partial thromboplastin time,
• Basal metabolic panel.
• Cardiac enzymes
• Thyroid-stimulating hormone
• Autoantibodies
• Viral / Rickettsial serologic tests
• Pericardial fluid
o Cell count with differential
o Lactate dehydrogenase (LDH),
o Protein
o Glucose
o Gram stain
o Bacterial cultures
o Smear for acid-fast bacilli staining,
o Adenosine deaminase
o Tuberculosis culture
o Viral cultures
o Cytology (tuberculosis/viral/ cancer)
• Chest radiograph
• Two-dimensional echocardiography
• CT scan
• MRI
• ECG/ EKG

ADDNEW

ANESTHESIA
Local Anesthesia

PROCEDURE
POSITION OF THE PATIENT: Sitting at 30-45° head elevation

• Skin was shaved at that site of needle insertion

• The local site was anesthetized with Lidocaine (1-2%).

• A small incision (approximately 5 mm) was made to decrease

the resistance during needle insertion.

• The subcutaneous tissue was separated with mosquito

grasping forceps.

• The needle was connected with a 3-way stopcock.

• The syringe with 1% Lidocaine was connected to the 3-way

stopcock on the opposite side of the needle connection.

• The transducer was connected on the side of the 3-way

stopcock.

• A sterile ECG recorder was attached to the metal part of the

needle.

• The needle inserted through the subxiphoid approach on the

left side under fluoroscopy.

• The needle and syringe was advanced until the needle tip is
posterior to the rib cage.

• The needle advanced towards the shoulder at an angle 15-20°

from the abdominal wall.

• While advancing the needle, aspirated with the syringe and

injected lidocaine for a better analgesic effect.

• The needle was advanced until fluid is aspirated in the syringe

/ the ECG monitor shows ST elevation.

• The ECG shows ST elevation, the needle was withdrawn

slowly with negative pressure on the syringe

• The needle was reinserted in a different direction very slowly

• Fluid was aspirated in the syringe.

• Hemorrhagic fluid was aspirated

 • A few milliliters of contrast medium are injected, was
observed surrounding the cardiac silhouette, indicating that
the needle tip is in the pericardial space.

• The contrast material was immediately disappeared; the

needle was in one of the cardiac chambers.

• The position of the needle was confirmed by injecting agitated

saline through the needle

• Contrast appeared in the pericardial space

• The needle tip was inside the pericardial space, a soft floppy-
tip guidewire was passed through the needle.

• This guidewire was wrapped around the heart.

• The needle was removed and a soft catheter with multiple

side holes was inserted over this guidewire.

• The guidewire was removed

• The catheter hub connected with the transducer and syringe

with a 3-way stopcock.

• The dressing was placed and secured the catheter to prevent

displacement.

• The catheter was flushed with 1-2 mL of fluid to prevent

blockage.

• Types of catheter - The pigtail catheter

The straight catheter

• The catheter was removed after _________hrs

• Drainage______ ml

AFTER PROCEDURE

• Monitor the B.P., temperature, heart rate

• Monitor the E.C.G
DURATION
_____min

POSTOPERATIVE CARE

• Take antibiotic medicine as prescribed

• Take pain medication as prescribed

COMPLICATIONS

•Laceration of coronary artery

•Laceration of coronary vein

•Pericardial tamponade

•Acute left ventricular failure with pulmonary edema

•Puncture or laceration of any cardiac chamber

•Bleeding

•Ventricular ectopic beats

•Atrial ectopic beats

•Arrhythmias

•Hypotension

•Pneumothorax

•Pulmonary edema

ADVISED