Pericadio Centesis

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Prof T.K.Parthasarathy

EMERGENCY INDICATION

Pericardial Tamponade
following major trauma to chest

Signs & Symptoms

  • Chest wall injury
  • Shallow / laboured breathing
  • Poor quality rapid pulse
  • Enlarged neck veins (CVP)
  • Low pulse pressure (difference between
    systolic and diastolic BP)
  • Anxious-Confused
  • State of Shock
  • Heart Sounds - Distant / Muffled
  • Tachycardia - Cyanosis

Objective

To aspirate the collection of blood in the pericardial sac and improve venous return to heart (relieve cardiac tamponade).

Require

Betadine or other skin prep solution Long (15 cm 6") 18 gauge needle & 20-50 cc syringe

Procedure

  1. Supine position
  2. Sterile skin prep (xiphoid area)
  3. 1% xylocaine local infiltration as needed
  4. A small puncture with a 11 blade knife on the skin just below and to the left of xiphoid process
  5. The long needle is positioned at 45 above the body surface and 45 to the right of midline
  6. Through the skin puncture the needle is advanced in the position as above cephalad (towards head) and towards the left scapula.
  7. With-draw the syringe and aspirate unclotted blood from pericaridal sac
  8. Improvement is usually seen on prompt withdrawal of pericardial collection
  9. Through the needle a catheter can be passed and aspiration carried out periodically till patient handed to trauma center for further surgical care.
  10. ECG monitoring before during and after procedure helps

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