Paediatrics: Pericardiocentesis

Pericardiocentesis

Indications

Therapeutic drainage of pericardial effusion or for diagnostic purposes.

Equipment

• Alcohol impregnated swab/antiseptic solution, e.g. 0.5% chlorhexidine.
• 21G needle or IV cannula and 10–20mL syringe.
• Sterile gloves, drapes, gown, and adhesive plaster.
• Sterile sample containers if pericardial fluid analysis intended.

Procedure

• Lay child on a 30° slope to cause effusion to pool inferiorly.
• Locate the insertion site; this lies just below the angle between the sternum and the left costal margin.
• Use sterile gloves and gown. Clean the site with antiseptic and place sterile drapes around the insertion site.
• Local anaesthetic infiltration may be appropriate.
• Insert needle connected to syringe at an angle of 30° to the skin and advance slowly, aiming towards the left shoulder. Gently aspirate the syringe as the needle is inserted.
• Stop when pericardial fluid (usually straw-coloured) is aspirated and remove the desired amount as indicated.
• Once drainage is complete, remove the needle and apply adhesive plaster.