Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Therapeutic: Impending cardiac tamponade.• Diagnostic.• Infectious pericarditis.• Rule out an oncologic process.• Compromise in the patient’s hemodynamic status. +++ Relative + • A blood dyscrasia in which a patient may have a significant bleeding complication.• A cutaneous infection in the area of the most feasible sights for pericardiocentesis.• 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.• Scalpel.• 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 proper technique.• 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 sternal border.• 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 beneficial.• Makes an orthopneic patient more comfortable.• May allow for most of the pericardial fluid to position inferiorly or closer to the drainage site. + • Prepare the subxiphoid area and left sternal border.• 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 needle.• 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 ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.