What Is Pericardiocentesis?

Pericardial puncture is a pericardial puncture technique that can be used as a confirmatory diagnosis and an emergency treatment to relieve pericardial tamponade when there is effusion, blood, or pus in the pericardial cavity. There are two ways: parasternal approach. It should only be used in cases with a large amount of pericardial effusion, otherwise the pleural cavity may be contaminated. Patient sitting or semi-recumbent. After disinfection of the forearm skin, anaesthesia with 1% procaine infiltration, use the pericardial puncture needle to pass through the 4th intercostal space on the left side of the sternum, pierce the pericardial cavity 1cm from the edge of the sternum, and aspirate the effusion. The approach to the xiphoid process. More commonly used. The patient is supine or semi-recumbent. Sterilize the skin of the thorax, infiltrate the anesthesia with 1% procaine, pierce the skin with a pericardial puncture needle between the left side of the xiphoid process and the costal cartilage arch, and then the needle tip and the skin obliquely upward and backward at a 45 ° angle Inside slowly entered. When entering the pericardial cavity through the pericardial pericardium, if there is a feeling of emptiness, the effusion can be tried aspiration. ^[1]

Basic Information

Chinese name

Pericardial puncture

Anesthesia

Local anesthesia

Indication

Patients with a large number of pericardial effusions and symptoms of cardiac tamponade

Contraindications

Pericardial effusion caused by aortic dissection, etc.

1. Local anesthesia.
2. Preoperative preparation (1) Routine disinfection treatment tray.
(2) 21FG venous trocar, tee switch, 10ml syringe, hole towel, gauze.
(3) Other materials such as 1% procaine solution, sterile gloves, test tubes, measuring cups, etc. Spare ECG, rescue medication, defibrillator and respirator.
(4) Perform a cardiac ultrasound examination before surgery to determine the size of the fluid level and the puncture site.

1. A large number of pericardial effusions with symptoms of cardiac tamponade should be punctured to relieve the symptoms of compression.
2. Extract pericardial effusion to assist diagnosis and determine the cause.
3. Intraperitoneal administration.

1. Aortic dissection causes pericardial effusion.
2. Those with enlarged heart and less effusion.
3. Pros and cons should be carefully considered for those with severe bleeding tendency or coagulopathy.

The general procedure is as follows.
1. Patients usually take a sitting or semi-recumbent position, exposing the chest and upper abdomen. Carefully pinch out the voiced-voicing world and choose a puncture point. Commonly used sites are the left margin of the sternum, the right margin of the sternum, the apex of the heart, and the subxiphoid process.
2. Disinfect the local skin, cover the disinfection hole towel, and perform local anesthesia at the puncture site from the skin to the pericardial wall.
3. Clamp the rubber tube connected to the puncture needle, and insert the puncture needle at the selected site after local anesthesia.
4. Slowly enter the needle under negative pressure. When you see the liquid flowing out of the needle tube, it indicates that the puncture needle has entered the pericardial cavity. If the heart beats the needle tip, you should retract the needle a little to avoid scratching the heart and fix the needle.
5. After entering the pericardial cavity, the assistant connects the syringe to the rubber tube, releases the clamp, and slowly draws the liquid. When the needle tube is full, the rubber tube should be closed with hemostats before removing the needle tube to prevent air enter. Record the amount of pumped liquid and keep the specimen for inspection.
6. After pumping, remove the needle or cannula, cover with sterile gauze, press for a few minutes, and fix it with adhesive tape. Indwell the catheter if necessary.

1. Strictly grasp the indications, because pericardial puncture is dangerous, it should be operated or instructed by an experienced physician, and puncture should be performed under ECG monitoring, which is safer.
2. Cardiac ultrasound must be performed before surgery to determine the size and puncture site of the fluid level. The largest fluid level and the closest point to the body surface are selected as the puncture site, or the puncture and fluid extraction under the guidance of ultrasound imaging is more accurate and safe. .
3. If the blood is drawn, stop the suction immediately, and closely observe the occurrence of cardiac tamponade.
4. The operation should be gentle, and the needle should not be strong and fast. After entering the pericardium, you should carefully check the feel of the needle at any time. If there is a sense of pulsation, the needle tip has touched the heart or has penetrated the heart muscle, and the needle should be withdrawn immediately. Be gentle when pumping or rinsing.
5. The pumping speed should be slow. The first pumping volume should be about 100m1, and the pumping volume will be 300 ~ 500ml each time to avoid the acute expansion of the heart caused by excessive pumping.

1. Postoperatively observe the patient's heart rate, heart rhythm, body temperature, breathing, blood pressure, etc. For dyspnea, loss of consciousness, chest tightness, shortness of breath, and acute pulmonary edema.
2. Apply antibiotics as appropriate to avoid infection at the puncture site and pericardium.