26.5 Manual of PCI - Pericardiocentesis

Step-by-step description of how to do pericardiocentesis:
1. Support patient (fluids, vasopressors)
2. Echo (if time allows)
3. Select approach
4. Prepare equipment
5. Prepare skin + drape
6. Local anesthetic
7. Advance needle aspirating
8. Bubble injection - echo
9. Insert wire into pericardium
10. Insert sheath (optional)
11. Insert pigtail
12. Measure pericardial pressure
13. Drain effusion
14. Send fluid for analyses
15. Repeat echo
16. Measure final pericardial pressure
17. Suture sheath + drain
18. CXR

[@Angmar9535]

Thank you!

[@cristianolisi3001]

Many thanks for sharing your knowledge. Your lessons are very helpful for quotidian job in our cathlab!

[@amrhanafymahmoud9829]

Thank you Dr for this illustrative video.

[@user-fr4bd7vd8e]

There is huge difference between draining chronic effusion with more than 2 cm separation with relatively stable patient and acute tamponade with < 1 cm separation and patient on verge of death. How do you avoid ventricle puncture in acute tamponade with mild effusion.

[@drgaganvelayudhan1733]

Thanks for the comprehensive coverage Sir! One practical difficulty is frequent obstruction of the pigtail by clots in case of hemorrhagic effusion. How would you prevent that?

[@manosbrilakis]

1. Aspirate every 4-6 hours and flush with 5 mL of normal saline
2. I insert the pigtail through a 6 French sheath - if pigtail becomes occluded sheath allows easy exchange for a new pigtail.

[@ASRRAF1990]

THK you Dr Brilakis. In which cases you leave pigtail in position and when you pull it out at the end of the procedure?

[@manosbrilakis]

Leave pigtail in in nearly all cases - it is removed when drainage is

[@ASRRAF1990]

@@manosbrilakis thank you for the kind answer.

[@ImranAli-rg3ht]

Love your work sir.... Sir make a lecture video on pneumothorax and pleural effusion extraction...... No doubt your videos have big impact on my profession....

[@manosbrilakis]

Sorry, I do not do these procedures

[@drgaganvelayudhan1733]

Thank you for the reply. Do you have any protocol for pain management in patients on pigtail for more than 1 day? Some patients find it distressing with the pigtail in situ

[@manosbrilakis]

No special protocol - Tylenol and NSAIDS first with opiates reserved for refractory pain. This also depends on the cause of the effusion (for example we give colchicine for pericarditis).

[@PeteHob]

Tylenol and NSAIDS first! Thanks to all the overprescribing docs leading to so called opioid/ opiate crisis.
By the way, I’ll have the propofol appetizer before this procedure.

[@tarekshaldah3087]

Great, thanks .
please can you explain to us the steps to implant the permanent pacemaker and the icd ?

[@manosbrilakis]

Sorry I do not do these procedures

[@shangz0216]

Thanks for the sharing.

[@mahmoud27898]

Thanks

[@areenal-taie6836]

Love it
Thank you very much

[@cubanitoglacies6957]

Thanks so much, Dr Brilakis!!
Could you share please, in patients who have “chronic” hydropericard with large amount of effusion (not emergency case) do you usually remove the whole volume of fluid from pericardium? Or do you remove only the part of effusion and the rest part will be removed by drainage system?

[@manosbrilakis]

I remove all the fluid and perform to echo to confirm that it has been drained. Still leave the drain in and record the volume drained. Thank you, Manos

[@cubanitoglacies6957]

Thanks for answer, doc! Your videos are very consecutive, keep going🙏

[@farukakturk5388]

Do you use crocodiles when performing without echo?

[@manosbrilakis]

I do not, but this could be useful

[@asemarida3503]

Dear Prof how could I do a workshop on cath lab with you?

[@drvivekmaheshagrawal]

Sir sometimes in obese patients, it is difficult to locate the subxiphoid space...what do we do then ? Flouroscopy can it help ??

[@manosbrilakis]

My preferred approach is to use echo: it tells you the best angle to reach the effusion and the distance of the pericardium from the skin