• A blood dyscrasia in which a patient may have
a significant bleeding complication.
• A cutaneous infection in the area of the most feasible sights
• A significantly elevated diaphragm, a grossly enlarged liver,
or profound ascites, which all change the standard landmarks of
inserting the pericardiocentesis needle in the subxiphoid area.
• Under such circumstances, use the intercostal approach.
• Povidone-iodine or equivalent sterilization substrate
to cleanse the subxiphoid area.
• 1% or 2% lidocaine or xylocaine.
• 25-gauge, 1.5-inch-long needle.
• 16- or 18-gauge needle, ≥ 1.5 inch.
• Floppy tip wire that can be introduced through the needle.
• Pigtail catheter with multiple side holes as well as an end hole.
• 3-way stopcock.
• 30-mL or 60-mL syringe and suture kit.
• ECG monitor, pulse oximeter, and blood pressure cuff.
• Infection and bleeding can be minimized with
• Pneumothorax (unusual).
• Laceration of the liver (unusual).
• Coronary injury (unusual).
• Cardiac perforation (unusual).
• Ideally, a patient should be continuously monitored
with echocardiography and fluoroscopy in an interventional radiology
or cardiac catheterization laboratory.
• Frequently, this is not an option, and bedside pericardiocentesis
without portable fluoroscopy is performed. In this circumstance,
the patient should be sedated.
• Respiratory and hemodynamic status should be monitored by assistants,
so that the physician can concentrate on performing the pericardiocentesis.
• Prepare and drape the subxiphoid area in the
usual sterile fashion.
• If the subxiphoid approach might be difficult (due to an unusually
located heart or elevated diaphragm), consider preparing the left
• All equipment should be readily available and an assistant should
be available to help with manipulation of needles, wires, and catheters.
• Supine position, with 10–30 degrees
of reverse Trendelenburg.
• Occasionally, the partially sitting position may be required or
• Prepare the subxiphoid area and left sternal
• Administer 1% or 2% lidocaine approximately
0.5–1 cm below the left costoxiphoid angle using a 25-
or 27-gauge 1.5-inch-long needle.
• Infiltration of the lidocaine should be superficial as
well as deep, pushing the needle superiorly, posteriorly, and leftward.
• Withdraw fluid each time the needle is passed deeper within the
skin and subcutaneous tissues.
• To allow for easier passage of the needle, precut the skin with
the scalpel before introducing the 16- or 18-gauge 1.5-inch to 2.5-inch
• Insert the larger needle at an approximate 30–45-degree angle
with the abdomen with constant negative pressure on the syringe.
• Monitor ECG very carefully for evidence of dysrhythmias or ST
segment changes (evidence ...
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