Emergency Medicine

PERICARDIAL ASPIRATION

Practical Procedures 475

COMPLICATIONS

1 Pain (inadequate sedation), thermal burn to skin (inadequate conduction).

2 Myocardial injury to epicardial and subepicardial tissue (repeated shocks).

3 Pacemaker malfunction (avoid area).

4 Post-cardioversion arrhythmia.

5 Excessive sedation with respiratory depression or hypotension.

PERICARDIAL ASPIRATION

INDICATIONS

1 Cardiac tamponade.

CONTRAINDICATIONS

1 Absolute: none in the critically unstable patient.

2 Relative: uncontrolled bleeding diathesis, lack of experience, delaying
emergency thoracotomy in traumatic tamponade (preferred option).

TECHNIQUE

1 Insert a 14-gauge i.v. cannula connected to a 20 mL syringe just below the
xiphisternum to the left of the mid-line.

2 Place at 30–45° angle, aiming for the tip of the left scapula, aspirating as the
need le is advanced (see Fig. 18.2).

3 Monitor the ECG looking for ectopic beats or change in morphology suggest-
ing the needle has contacted the myocardium. If this occurs, withdraw
slightly until the injury pattern resolves.

4 Advance slowly until the pericardial sac is reached. A ‘giving’ sensation
suggests penetration of the pericardium.

5 Aspirate f luid or blood from the pericardial space. Withdrawal of just
20–30 mL can dramatically improve the patient’s haemodynamic status.

6 Use of the Seldinger technique allows a pig-tail catheter to be inserted for
further f luid removal.

7 Monitor the patient for recurrent tamponade, which may result from cathe-
ter blockage or f luid reaccumulation.