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Cardiology
Pericardiocentesis
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
9 sections · 92 slides
Overview and Indications
- Definition of pericardiocentesis
- Historical origins of the procedure
- Cardiac tamponade defined
- Diagnostic indications
- Therapeutic indications
- Non-drainage access to the pericardial space
Anatomy of the Pericardium
- Layers of the pericardium
- Structures contained within the pericardial sac
- Heart within the pericardial sac
- Structures at risk during needle passage
- Normal pericardial fluid volume
- Acute versus chronic fluid accumulation
- Pathophysiology of tamponade
- Distribution of pericardial effusion
Clinical Assessment
- Symptoms of pericardial effusion
- Physical findings in cardiac tamponade
- Haemodynamic compromise in tamponade
- Echocardiography in cardiac tamponade
- Enlarged cardiac silhouette on frontal chest radiograph
- Confirmatory imaging modalities
- Invasive confirmation of tamponade
- Treatment options for cardiac tamponade
- Temporising measures before drainage
- Surgical drainage and balloon pericardiotomy
- Haemodynamic response to drainage
Aetiology and Urgency
- Aetiologies of pericardial effusion
- Iatrogenic causes of pericardial effusion
- Trauma and procedural perforation
- Nature of the pericardial fluid
- Classification of Pericadial Effusion
- Urgency scoring for pericardiocentesis
- Indications for surgery rather than needle drainage
Setting and Equipment
- Preferred location for the procedure
- Performing the procedure outside the laboratory
- Pre-procedure echocardiography
- Patient positioning for pericardiocentesis
- Electrocardiographic needle monitoring
- Contents of the pericardiocentesis kit
Technique
- Consent and preparation of the field
- Sequence of the procedure
- Approaches to needle entry
- Needle insertion sites for pericardiocentesis
- Pericardiocentesis Puncture Site: Needle Path
- Pericardiocentesis Puncture Site, Advantages and Disadvantages
- Imaging guidance options
- Echocardiographically guided subxiphoid approach
- Bedside handheld echocardiography
- Agitated saline confirmation of needle position
- Fluoroscopic guidance
- Computed tomography guidance
- Access to loculated effusions
- Elective versus emergency pericardiocentesis
- Local anaesthesia and the buddy needle
- Needle advancement and pressure monitoring
- Subxiphoid needle path
- Needle selection for pericardiocentesis
- Parasternal approach
- Apical approach
- Appearance of aspirated pericardial fluid
- Pressure measurement to localise the needle
- Volume of fluid to withdraw acutely
Catheter Drainage and Aftercare
- Guidewire and dilator insertion
- Drainage catheter selection and position
- Drainage catheter position on chest radiography
- Pericardial fluid analysis
- Catheter care and duration of drainage
- Catheter obstruction and failure to drain
Contraindications and Complications
- Contraindications related to the effusion
- Coagulopathy and structural rupture
- Complication rates
- Structures injured during pericardiocentesis
- Recognising laceration of a cardiac structure
- Avoiding inadvertent puncture
- Pericardial decompression syndrome
- Dysrhythmias during the procedure
Summary
- Key points on indications and assessment
- Key points on technique and complications
- References
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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