1. Monitor vitals, ECG at all times.
2. Prep xiphoid and below and give LA (if time allows)
3. 16-18g angicath attached to large syringe with 3-way
4. Assess if large mediastinal shift has moved the heart.
Puncture skin 1-2cm inferiorly to xiphocondral junction, 45o to
skin. Advance needle cephalad toward tip of left scapula.
5. If adanced into heart, extreme ST-T waves or wide/large QRS
complexes are seen ("current of injury"). Withdraw until previous
trace apears. Prem beats may also occur.
6. When tip enters bld filled sac, aspirate as much blood as
possible. The heart expands more --> current of injury may
apear. Withdraw slightly. If persisting, withdraw needle
7. When finished, remove syringe attach a 3 way stopcock, leaving it
closed. Secure into place. Could also apply the Seldinger
technique with flexy guidewire through needle and a 14g catheter over
8. If tamponade persists, open stopcock and reaspirate
sack. Suture or tape a plastic pericardiocentesis catheter into
place with a small dressing for continued decompression en route to
definitive surgery / elsewhere. All pts requiring
pericardiocentesis require sternotomy.
Getting ventricular blood, not pericardial blood.
Lacerating myocardium or a coronary vessel.
New haemopericardium (though myocardium is usually self-sealing)
Great vessel puncture & worse tamponade.
Oesophageal puncture & mediastinitis
Peritoneal puncture with peritonitis.