video review: emergent pericardiocentesis

20 Feb

Cribbed from this somewhat long but still useful NEJM procedure video (if you only watch 3 minutes, start at the 5:30 mark):

 
QUICK PEARLS:

ultrasound guided (subxyphoid vs parasternal), ECG monitored (alligator clip to spinal needle), or blind approach (ballsy)

insert spinal needle through skin with stylet in place (avoids tissue biopsy), then take stylet out and advance with syringe attached

3-way stopcock between needle & syringe is handy for drainage assist

blind approach: subxyphoid, 45 degree angle, aim toward left shoulder

ECG-clip approach:

  • watch for ST elevations (this is too far–you’re touching the myocardium)
  • withdraw a bit until no ST elevations, then try to aspirate/reapproach

 

 

References: NEJM youtube video

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