Last reviewed 01/2018

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.