A Practical Approach to Pericardiocentesis With Periprocedural Use of Ultrasound Training Initiative

Tamponade is a life-threatening condition characterized by fluid accumulation in the pericardium, which compresses the cardiac chambers, impairs diastolic filling, and can lead to clinical shock. The diagnosis is a clinical one that is supported by echocardiographic findings. Pericardiocentesis is the definitive treatment for tamponade; however, it remains a challenge for trainees because of the infrequent exposure compared with other invasive procedures. Moreover, this technique, unlike others, can lead to serious complications including cardiac perforation and arrhythmia. There has been increased attention to periprocedural use of ultrasound in various techniques, particularly pericardiocentesis, given its ability to assess the pericardial effusion as well as the safety and feasibility of the procedure from various trajectories to minimize major and minor complications. As such, periprocedural use of ultrasound for pericardiocentesis has emerged as the preferred initial technique for pericardiocentesis. We outline a simple stepwise approach to prepare and perform pericardiocentesis, facilitated by periprocedural ultrasound, including practical tips from our centre's experiences. These include the proper assessment of the target area defined as the most pericardial fluid with the least interfering structures and troubleshooting the introduction of the needle into the pericardium. Absolute contraindications are few and often require surgery, but knowledge of them is mandatory when assessing patients for pericardiocentesis.