Pericardiocentesis
(Last Updated - 3/11/2017)

Date of Procedure:

Indication:
     Large Circumferential Pericardial Effusion (+/- Cardiac Tamponade)

Brief History:
          Mr. X is a 72 year-old man who presented with...

Procedure:
          Informed consent was obtained. NPO status for the past 8 hours was confirmed with the patient. A time-out was performed. The subxiphoid region was prepped and draped in a sterile fashion. Local anestehesia was given via Lidocaine. Under ultrasound guidance, a centesis needle was introduced under the xiphoid process and directed posteriorly toward the tip of the right scapula until the pericardial space was entered and fluid aspirated. Serosanguinous fluid was aspirated and the needle removed after advancement of a catheter. Agitated saline was then injected with live ultrasound imaging of the agitated saline bubbles within the pericardial space to confirm catheter placement. Pericardial fluid was then removed for testing. A pigtail catheter was then inserted through the introducer and again placement was confirmed via agitated saline injection. The pigtail catheter was then connected to a vacuum and drained into a large bottle vacuum-sealed container for further analysis. A total of 450 cc's of fluid was removed. The catheter was then sutured in place to the anterior chest wall and dressed with a sterile dressing for periodic drainage.
          The patient tolerated the procedure well and no complications were encountered. Estimated blood loss was minimal.

Follow-Up:
          The plan will be...



Procedure:
     -With echo guidance, locate best approach site (least tissue-to-pericardial fluid space)
     -Mark the planned area of entry
     -Cleanse and sterilize the area
     -Drape with the procedure drape (hole in the middle)
     -Local Lidocaine
     -Using angiocath needle (needle with sheath over it), advance with negative suction until pericardial fluid is obtained
     -Confirm placement with agitated saline
     -Advance the sheath very slightly and remove the needle
     -Thread guidewire through the sheath
     -Widen site with small scalpel knick
     -Advance dilator over the wire but keep wire in
     -Remove the dilator and insert it into the permanent sheath
     -Advance the permanent sheath with the dilator in it over the wire (not all the way) and remove the guidewire
     -Test that you are still in the pericardial space with agitated saline
     -Remove pericardial fluid for analysis with a 60 cc syringe and fill the syringe
     -Pass pigtail catheter through the access sheath (not all the way)
     -Confirm placement with agitated saline
     -Connect the pigtail catheter to the drainage tube and point into vaccuum suction bottle
     -Once done, disconnect the pigtail catheter from the drainage tubing and flush with 5 cc's of Heparinized saline then cap off with a 3-way stopcock
     -Make sure access sheath catheter is flushed and closed off too
     -Give localized Lidocaine in area of sutures
     -Suture access sheath to the skin
     -Curl up pigtail catheter and access sheath catheter and cover with Tegaderms
     -Done



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