0071643192.pdf

INTERPRETATION OFRESULTS

■ Removal of even 30–50 mL may result in marked clinical improvement.

■ Except in trauma or ventricular wall rupture, pericardial fluid should have

a lower hematocrit than venous blood, otherwise suspect that the needle

has entered a cardiac chamber (most likely the right ventricle).

■ Injection of a small amount of contrast under fluoroscopy can disclose

intracardiac placement.

Thoracentesis

INDICATIONS

■ Evacuation of air: Anterior approach

■ Temporary treatment of tension pneumothorax

■ Treatment of stable pneumothorax

■ Evacuation of fluid: Posterior approach

■ Analysis of pleural effusion

■ Treatment of symptomatic pleural effusion or tension hydrothorax

CONTRAINDICATIONS

■ Absolute: Needle insertion through an infected area

■ Relative: Readily available tube thoracostomy if needed

■ Bleeding diatheses or on anticoagulants when treating stable PTX

TECHNIQUE

■ Evacuation of air: Anterior approach

■ Patient supine, head elevated 30°

■ 14- to 18-Ga needle with or without catheter

PROCEDURES AND SKILLS

Cardiac tamponade is one of

the five Hs and five Ts that

represent the most common

and potentially treatable

causes of PEA.

The intercostal neurovascular

bundle underlies each rib.

During thoracentesis or

thoracostomy, enter the chest

just above the ribto avoid

the neurovascular bundle.

A tension pneumothorax is

treated with either immediate

thoracostomy or with

thoracentesis (“needle

decompression”) followed by

thoracostomy.

FIGURE 19.1. Subxyphoid approach for pericardiocentesis.

(Reproduced, with permission, from Wilson RF. Injury to the heart and great vessels. In: Henning

RS, ed. Critical Care Cardiology. New York: Churchill Livingstone, 1989.)