Pericardiocentesis (removal of pericardial fluid)
It is the mainstay of management because it provides rapid relief and restore the circulation and diastolic filling of the ventricles. Unless situation is immediately life-threatening, tapping should be done by an experienced personnel under echo or fluoroscopic guidance with ECG monitoring.
Procedure: Left subxiphoid approach with patient propped up to 45 degree is preferred. Rarely apical or parasternal approach may be required in loculated effusions. The procedure is as follows:
The patient is made to lie in a propped up position with backrest.
The patient is premedicated with atropine and diazepam.
The skin over the pericardium and upper part of the abdomen is shaved.
Under aseptic precautions and local anaesthesia, large bore long needle or I.V. cannula connected to a syringe is inserted and then connected to a 3-way stopcock for rapid aspiration. The fluid is continuously aspirated. Fluid is removed as much as possible till patient feels relief in dyspnea and BP is restored above 90 mmHg.
If at any stage during procedure, frank blood is seen entering the syringe, the tip of the needle should be repositioned.
Always look at the ECG monitor for any VPC as this may indicate the presence of the needle in the myocardium.
If the fluid drawn is purulent, then it should be drained by an indwelling catheter connected to an underwater seal.
After removal of the fluid, patient is made to lie comfortably on the bed and observed for pulse, BP for few hours. The I.V. line is maintained during this period.