PROCEDURE 45 • Advanced cardiac life support knowledge and skills are needed. • Knowledge of sterile technique is required. • Clinical and technical competence in the performance of pericardiocentesis is necessary. • Knowledge of cardiovascular anatomy and physiology is needed. • Pericardial effusion is the abnormal accumulation of greater than 50 mL of serosanguineous fluid within the pericardial sac. • A pericardial effusion can be noncompressive or compressive. With a compressive effusion, increased pressure is found within the pericardial sac, which may result in cardiac tamponade and resistance to cardiac filling. • The presentation of acute and chronic fluid accumulation varies. A rapid collection of fluid (over minutes to hours) may result in hemodynamic compromise with volumes of less than 250 mL. Chronically developing effusions (over days to weeks) allow for hypertrophy and distention of the fibrous parietal membrane.2 Patients with chronic effusions may accumulate greater than or equal to 2000 mL of fluid before exhibiting symptoms of hemodynamic compromise.1–4 • Symptoms of cardiac tamponade are not specific. Patients may have signs and symptoms of an associated disease. With a decrease in cardiac output, the patient often has development of tachycardia, tachypnea, pallor, cyanosis, impaired cerebral and renal function, diaphoresis, hypotension, neck vein distention, distant or faint heart sounds, and pulsus paradoxus.1–3 • The amount of fluid in the pericardium is evaluated through chest radiograph, two-dimensional echocardiogram, and clinical findings. • When cardiac tamponade or a large enough effusion to warrant drainage is verified, a pericardiocentesis is performed to remove fluid from the pericardial sac. An acute tamponade resulting in hemodynamic instability necessitates an emergency procedure. Blind pericardiocentesis should be performed only in extreme emergency situations.4 • Pericardiocentesis commonly is performed via a subxiphoid approach. • Two-dimensional echocardiography is recommended to assist in guiding the needle during the pericardiocentesis.8 • This procedure may be performed in the cardiac catheterization laboratory with fluoroscopy. • Inability to obtain pericardial drainage, reaccumulation of pericardial fluid, or cardiac injury may progress into cardiac tamponade, which necessitates urgent or emergent chest exploration. • Pericardiocentesis tray (or thoracentesis tray) • 16-gauge or 18-gauge, 3-inch cardiac needle or catheter over the needle • Antiseptic solution (e.g., 2% chlorhexidine-based preparation) • Two packs of 4 × 4 gauze sponges • No. 11 knife blade with handle (scalpel) • Sterile 50-mL to 60-mL, 10-mL, 5-mL, and 3-mL syringes • Masks, goggles or face shields, surgical head covers, sterile gowns, and gloves • Culture bottles and specimen tubes for fluid analysis Additional equipment as needed includes the following: • Emergency cart (defibrillator, emergency respiratory equipment, emergency cardiac medications, and temporary pacemaker) • Two-dimensional echocardiography equipment • Echocardiogram contrast medium • If continuous drainage is necessary:
Pericardiocentesis (Perform)
PREREQUISITE NURSING KNOWLEDGE
EQUIPMENT
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45: Pericardiocentesis (Perform)
