HLC 1719 No. of Pages 5
HOW-TO-DO-IT
Heart, Lung and Circulation (2015) xx, 1–5 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.11.009
Pericardiocentesis – How to do it Robert Gluer, MBBS *, Dale Murdoch, MBBS, FRACP, Haris M. Haqqani, MBBS (Hons), PhD, FRACP, FCSANZ, FHRS, Gregory M. Scalia, MBBS, FRACP, Darren L. Walters, MBBS, FRACP, MPhil The Prince Charles Hospital, School of Medicine, The University of Queensland, Brisbane, Australia Received 2 November 2014; accepted 15 November 2014; online published-ahead-of-print xxx
Pericardiocentesis is an important diagnostic and therapeutic technique, with the potential for significant morbidity and mortality if performed incorrectly. This article attempts to cover the anatomy, preparation, and techniques necessary to successfully perform pericardiocentesis. Keywords
Pericardiocentesis Cardiac tamponade Pericardial disease Pericardial aspiration Pericardial effusion
Pericardiocentesis has a long history, with early recognition of severe complications. It was first described in 1653 by Riolanus, who described trephination of the sternum to relieve fluid surrounding the heart [1]. The procedure fell out of favour due to frequent complications until development of ultrasound guided technique in the 1970s.
Indications The primary indication for pericardiocentesis is cardiac tamponade. This is a clinical diagnosis with echocardiographic confirmation, which is suggested by pulsus paradoxus - a highly sensitive (98%) and specific (83%) sign of cardiac tamponade [2] (Figure 1). Beck’s triad of jugular venous distension, distant heart sounds, and hypotension may be present. On ECG, a low voltage QRS (20 mm) or recurrent effusion should be considered for pericardiocentesis (class IIa
recommendation), but a non-malignant effusion is unlikely to develop tamponade regardless of initial chamber collapse or size [5]. A diagnostic tap for a small effusion may be considered (class IIb recommendation) [3], or a persistent effusion [4], but not if the effusion is resolving or diagnosis can be made from other investigations. The majority (83%) of procedures are undertaken for tamponade [5].
Contraindications Aortic dissection is an absolute contraindication for pericardiocentesis [3]. There is a risk of increased bleeding and extension of the dissection, and aortic dissection with tamponade is an indication for immediate surgery. Relative contraindications are uncorrected coagulapathy or anticoagulant therapy; thrombocytopaenia with a platelet count of
HOW-TO-DO-IT
Heart, Lung and Circulation (2015) xx, 1–5 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.11.009
Pericardiocentesis – How to do it Robert Gluer, MBBS *, Dale Murdoch, MBBS, FRACP, Haris M. Haqqani, MBBS (Hons), PhD, FRACP, FCSANZ, FHRS, Gregory M. Scalia, MBBS, FRACP, Darren L. Walters, MBBS, FRACP, MPhil The Prince Charles Hospital, School of Medicine, The University of Queensland, Brisbane, Australia Received 2 November 2014; accepted 15 November 2014; online published-ahead-of-print xxx
Pericardiocentesis is an important diagnostic and therapeutic technique, with the potential for significant morbidity and mortality if performed incorrectly. This article attempts to cover the anatomy, preparation, and techniques necessary to successfully perform pericardiocentesis. Keywords
Pericardiocentesis Cardiac tamponade Pericardial disease Pericardial aspiration Pericardial effusion
Pericardiocentesis has a long history, with early recognition of severe complications. It was first described in 1653 by Riolanus, who described trephination of the sternum to relieve fluid surrounding the heart [1]. The procedure fell out of favour due to frequent complications until development of ultrasound guided technique in the 1970s.
Indications The primary indication for pericardiocentesis is cardiac tamponade. This is a clinical diagnosis with echocardiographic confirmation, which is suggested by pulsus paradoxus - a highly sensitive (98%) and specific (83%) sign of cardiac tamponade [2] (Figure 1). Beck’s triad of jugular venous distension, distant heart sounds, and hypotension may be present. On ECG, a low voltage QRS (20 mm) or recurrent effusion should be considered for pericardiocentesis (class IIa
recommendation), but a non-malignant effusion is unlikely to develop tamponade regardless of initial chamber collapse or size [5]. A diagnostic tap for a small effusion may be considered (class IIb recommendation) [3], or a persistent effusion [4], but not if the effusion is resolving or diagnosis can be made from other investigations. The majority (83%) of procedures are undertaken for tamponade [5].
Contraindications Aortic dissection is an absolute contraindication for pericardiocentesis [3]. There is a risk of increased bleeding and extension of the dissection, and aortic dissection with tamponade is an indication for immediate surgery. Relative contraindications are uncorrected coagulapathy or anticoagulant therapy; thrombocytopaenia with a platelet count of
