TY  - CHAP
M1  - Book, Section
TI  - Pericardiocentesis
A1  - Gomella, Tricia Lacy
A1  - Eyal, Fabien G.
A1  - Bany-Mohammed, Fayez
PY  - 2020
T2  - Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 8e
AB  - Emergency  evacuation  of  air  or  fluid  from  the  pericardial  space  in  the  treatment  of  cardiac  tamponade  (inability  of  the  heart  to  expand  with  decreased  stroke  volume  and  cardiac  output)  and  hemodynamic  instability  caused  by  pericardial  effusion  (accumulation  of  excess  fluid  in  the  pericardial  space)  or  pneumopericardium  (accumulation  of  air  in  pericardial  space).  Early  recognition  and  intervention  are  paramount  and  can  be  lifesaving  because  mortality  can  be  high  (up  to  67%).Cardiac  tamponade  secondary  to  a  pericardial  effusion.  A  rare  but  life-threatening  complication  of  central  venous  catheters,  including  PICC  and  UVC.  Incidence  is  1%  to  3%.  Etiology  is  unclear,  but  proposed  causes  include  a  direct  puncture  of  a  vessel  or  myocardium  (areas  of  weakness  and  incomplete  muscularization  may  occur  in  neonates)  by  the  catheter  tip  during  insertion  or  delayed  perforation  secondary  to  erosion  of  the  cardiac  or  vascular  wall.  Keep  a  high  index  of  clinical  suspicion  in  a  neonate  who  has  a  central  line  and  suddenly  has  cardiovascular  collapse  that  does  not  respond  to  resuscitation  or  has  resistance  to  external  cardiac  compressions  and  has  no  air  leak  by  thoracic  transillumination.  Possible  signs  include  hypotension,  tachycardia,  decreased/diminished  heart  signs,  poor  perfusion,  decreasing  arterial  saturation,  decreased  heart  sounds,  increased  jugular  venous  pressure  (very  difficult  to  assess  in  an  infant),  pulseless  electrical  activity  with  a  central  line,  and  pulsus  paradoxus  (a  drop  in  systolic  blood  pressure  >10  mm  Hg  during  inspiration  seen  on  blood  pressure  waveform  and  on  echocardiography).  The  Beck  triad  (hypotension,  increased  jugular  venous  pressure,  and  distant  heart  sounds)  is  described  in  cardiac  tamponade.  Pericardial  effusion  is  more  common  with  lines  in  the  right  atrium;  the  median  time  to  occurrence  is  3  days  after  catheter  insertion  (range,  0–37  days).  A  chest  radiograph  may  not  be  diagnostic;  an  echocardiogram  is,  but  may  delay  treatment.  Note:  Pericardial  effusion  and  cardiac  tamponade  can  occur  with  a  central  venous  catheter  in  the  correct  position.  It  is  felt  that  total  parenteral  nutrition  (especially  intralipid)  permeates  into  the  interstitium  and  into  the  pericardial  sac.Cardiac  tamponade  secondary  to  a  pneumopericardium.  Rare  but  very  dangerous,  and  usually  occurs  with  other  air  leak  syndromes,  severe  lung  pathology,  a  history  of  vigorous  resuscitation,  and/or  a  history  of  assisted  ventilation.  Early  recognition  (see  signs  above)  and  intervention  are  important.  A  chest  radiograph  can  be  diagnostic  with  lucency  around  the  cardiac  border.  (See  Figure  12–22)To  obtain  pericardial  fluid  for  diagnostic  studies  in  cases  of  pericardial  effusion.  Pericardial  effusion  is  rare  in  neonates  and  most  commonly  occurs  in  a  hydropic  or  septic  infant.  Other  causes  include  thyroid  dysfunction,  cardiac  and  pericardial  tumors  (intrapericardial  mixed  germ  cell  tumor  and  intrapericardial  teratoma  have  been  reported  in  infants),  congenital  anomalies  (diaphragmatic  hernia/eventration,  ruptured  ventricular  diverticulum),  postoperative,  and  idiopathic.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=1168356483
ER  -