Tamponade & Pericardiocentesis

-CXR not sensitive – minimum 200-250cc (large) pericardial fluid produces cardiomegaly

-TEMPORIZE by pushing fluids to increase preload and Trendelenburg

-APPROACHES include subX vs parasternal: choose based on whichever view you see the largest pocket of fluid

-may use central line kit

-Place needle just inferior and lateral to the right of the subX process. Aim at pt’s left shoulder. Numb the tract. Try to visualize needle on US but if pt is in extremis, it’s ok not to (basically blind procedure) as long as you advance cautiously. Take off as much fluid as you can.

-GOAL: Take off enough fluid to stabilize the patient. If tamponade recurs, repeat pericardiocentesis and consider placing a catheter/drain (Rosen’s)

-COMPLICATIONS: myocardial perforation, pneumothorax, laceration of LIMA (esp parasternal approach) or coronaries, dysrhythmias, liver lac (expected as part of subX approach)

5.8.17

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