Needle pericardiocentesis

Last Updated on by FRCEM Intermediate

 

Landmark:

Puncture the skin 1 – 2 cm inferior to the left of the xiphochondral junction at a 45-degree angle to the skin and advance the needle cephalad aiming towards the tip of the left scapula

Monitor

ECG -If the needle is advanced too far (i.e. into ventricular muscle), an injury pattern appears on the ECG (e.g. extreme ST-T wave changes or widened and enlarged QRS complex), indicating the needle should be withdrawn until the previous baseline ECG tracing reappears

Complications

  • Aspiration of ventricular blood instead of pericardial blood
  • Laceration of ventricular epicardium/myocardium
  • Laceration of coronary artery or vein
  • New haemopericardium secondary to lacerations of above structures
  • Ventricular fibrillation
  • Pneumothorax secondary to lung puncture
  • Puncture of great vessel with worsening of tamponade
  • Puncture of oesophagus with subsequent mediastinitis
  • Puncture of peritoneum with subsequent peritonitis

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