Pericardiocentesis Flashcards
What is the primary indication for performing a pericardiocentesis?
Cardiac tamponade, caused by a fluid or air collection in the pericardial sac.
What are the contraindications for pericardiocentesis?
Asymptomatic pericardial collections.
No absolute contraindications in emergency relief of cardiac tamponade.
What are some complications associated with pericardiocentesis?
- Pneumopericardium
- Pneumomediastinum
- Pneumothorax
- Cardiac perforation
- Arrhythmia
- Hypotension (if large effusion is drained)
What precautions should be taken before performing a pericardiocentesis?
Universal Precautions will be used.
What procedure must be performed prior to each pericardiocentesis according to Joint Commission Standards?
Time out.
What is the recommended pain management technique if time permits before a pericardiocentesis?
Inject local anesthetic 0.25 to 1 mL of 1% Lidocaine within 1-2 cm of the xiphoid process.
What is the initial step in the technique for pericardiocentesis?
Cleanse skin over xiphoid, precordium and epigastric area with antiseptic solution and allow to dry.
At what angle should the needle be elevated during needle insertion for pericardiocentesis?
30-40 degrees.
How should the needle be directed during insertion in pericardiocentesis?
Toward the left shoulder.
What should be done while advancing the cannula during pericardiocentesis?
Apply constant gentle suction on the syringe.
What indicates that the needle is in the pericardial space during fluid aspiration?
Hemodynamic improvement after aspiration of 10-20 ml of fluid.
What should be noted about small single lumen catheters during pericardiocentesis?
They may easily become blocked.
What imaging technique can assist in planning needle entry for pericardiocentesis?
Ultrasound imaging.
What can positive transillumination indicate before the procedure?
The presence of free air.
What are some possible outcomes upon initial aspiration of the pericardium?
- Air
- Serous fluid
- Serosanguineous or grossly bloody fluid
- Fluid resembling infusate from a central line
What is a key difference in the effect of aspirating blood from the heart versus draining from the pericardial space in infants?
Aspirating 10mL of blood from the heart will have minimal effect, while draining 5-15mL from the pericardial space can result in significant hemodynamic improvement.
What might be the consequence of draining a large volume from the pericardial space?
It can alter cardiac preloading significantly.
What emergency procedure might be performed in extreme cases of cardiac tamponade?
Pouring betadine over the subxiphoid area followed by ‘blind’ aspiration using any available needle and syringe.
