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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on the ECG (e.g. extreme ST-T wave changes or widened and enlarged QRS complex), indicating the needle should be withdrawn until the previous baseline ECG tracing reappears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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