PERICARDIOCENTESIS Flashcards
MANAGEMENT
INDICATION
Obstructive shock due to pericardial tamponade
EQUIPMENT: EMERGENCY PROCEDURE (cardiac arrest or hemodynamic collapse)
18-gauge spinal needle
20-mL syringe
EQUIPMENT: URGENT PROCEDURE (semi-stable); in addition to the above equipment:
chlorhexidine sponge
Sterile gown
Sterile gloves
Sterile drape
Lidocaine 1% with epinephrine
Suture and needle holder
Ultrasound
Sterile ultrasound probe cover
J-tipped guidewire
Dilator
8-French pigtail catheter
Three-way stopcock
TECHNIQUE: ULTRASOUND GUIDED APPROACH
Evaluate three windows: Subxiphoid, apical, and parasternal.
Re-image If repositioned,
Clean and inject 2.5-5 mL of local
Place an 18-gauge spinal needle on the 20-mL syringe.
Insert the needle at the location
Slowly advance and aspirate
Three-way stopcock: agitate saline and air between two syringes and then rapidly inject the saline with bubbles through the needle while visualizing with ultrasound; visualizing echogenic saline bubbles within the pericardium confirms proper location of the needle tip.
Aspirate until clinical improvement.
Insert J-tipped guidewire through the finder needle.
Remove the needle.
Insert the dilator over the guidewire.
Remove the dilator.
Place the pigtail catheter over the guidewire.
Remove the guidewire and secure the pigtail catheter to the skin.
POST-PROCEDURE
Consult Cardiology or Thoracic Surgery for definitive management.
Obtain a chest radiograph to ensure that there is no pneumothorax.
Repeat echocardiography to demonstrate improvement in ventricular filling.
