Pericardiocentesis site

Pericardiocentesis is a common examination and treatment method. The puncture site is mainly at the intersection of the xiphoid process and the left costal margin, usually in the fifth intercostal space on the left, 1 to 2 centimeters inside the boundary of cardiac dullness. When performing pericardiocentesis, it must be performed under sterile conditions, local anesthesia must be performed, the puncture site should not be too deep to avoid puncturing the heart, and preoperative and postoperative care must be strengthened.

principle

In addition, when there is a large amount of pericardial effusion, the patient's blood circulation is seriously disturbed, venous blood cannot return to the heart smoothly, and the heart's blood discharge function is impaired. Pericardiocentesis to release a large amount of effusion can alleviate the patient's symptoms or even eliminate them.

Pericardiocentesis must be performed under aseptic technique, with local application of procaine anesthesia. The puncture site should not be too deep to avoid puncturing the atrium, ventricle or coronary artery and causing large amounts of blood to accumulate in the pericardial cavity. Although pericardiocentesis has certain risks, it is still a relatively safe diagnostic and treatment method if it is performed carefully and strictly according to the operating procedures.

Indications

1. Determine the nature of pericardial effusion;

2. Relieve cardiac tamponade;

3. Treatment of pericardial empyema;

4. Preoperative judgment of pericardial fenestration.

in principle

1. It is better to go left than right;

2. It is better to go down than to go up;

3. It is better to be outside than inside;

4. Straight is better than slanted

How to operate

1. X-ray and/or ultrasound examinations should be performed before surgery to determine the puncture site and estimate the extent of fluid accumulation. Surgery is not recommended for patients with a small amount of fluid accumulation.

2. Choose a suitable body position. For example, if the needle is inserted from the apex of the heart, it is usually better to sit down. If the needle is inserted under the xiphoid process, it is usually better to lie on a slope with a pillow under the waist and back.

3. Instruct the patient not to cough or take deep breaths during the operation. If necessary, an appropriate amount of sedatives can be given before the operation.

4. Commonly used puncture methods include the following two methods: ① Precordial puncture: insert the needle inside the cardiac dullness boundary between the left 5th and 6th intercostal spaces, and then pierce the pericardial cavity backward and inward toward the spine. After the puncture needle tip enters the subcutaneous tissue, the assistant connects the syringe to the rubber tube behind the puncture needle and draws suction to create negative pressure. When the puncture needle enters the pericardial cavity, the rubber tube is immediately filled with liquid. At this time, stop inserting the needle to avoid touching the myocardium or damaging the coronary artery; ② Substernal puncture: The puncture point is made below the junction of the xiphoid process of the sternum and the left seventh costal cartilage. The puncture direction is 45° to the abdominal wall, and the needle is inserted upward, backward, and slightly to the left into the posterior and lower part of the pericardial cavity. The rest of the operations are the same as above. If conditions permit, it can be performed under ultrasound guidance.