Paediatrics: Pericardiocentesis

Pericardiocentesis

Indications

Therapeutic drainage of a 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 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 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 needle is inserted.

• Stop when pericardial fluid (usually straw-coloured) is aspirated and remove desired amount as indicated.

• Once drainage is complete, remove needle and apply adhesive plaster.