Pericardiocentesis

Pericardiocentesis or cardioparacentesis is the drainage of fluid from the pericardial cavity. It is indicated for:

• treatment of pericardial effusion; often used in the emergency situation for relief of pericardial tamponade
• diagnosis of cause of effusion

There are two approaches to the pericardial sac:

• infrasternal angle:
  • pass hollow needle between left side of xiphisternum and costal cartilage
  • direct needle superiorly, posteriorly and slightly laterally
• fifth or sixth intercostal space:
  • left interspace is traversed by needle or dissected out close to the sternum
  • care must be taken to identify and avoid the internal thoracic vessels
  • more suitable site for long-term drainage of an effusion by passage of a tube

The patient should be monitored by ECG; when the needle impinges upon the pericardium, abnormal electrical activity may be witnessed.

Note that paracentesis is also used to describe the drainage of ascites.