The Effect of Operator Experience on Periprocedural Adverse Events Associated With Pericardiocentesis

To determine the effect of operator experience on the adverse events associated with pericardiocentesis. A secondary objective was to determine whether adverse events with inexperienced operators were less common in the presence of an experienced supervisor.

Prospective observational clinical study.

Private practice specialty teaching hospital.

Forty-five client-owned dogs with pericardial effusion undergoing pericardiocentesis.

Pericardial effusion was identified via point-of-care ultrasound (POCUS). Pericardiocentesis was performed according to standard protocol, with the operator chosen based on availability. An ECG was recorded before, during, and after pericardiocentesis, with optional postprocedural telemetry monitoring. POCUS was repeated to monitor for recurrent effusion. Operators completed a questionnaire to report their experience level and adverse events associated with pericardiocentesis. Medical records were reviewed to verify diagnostic results and adverse event occurrence.

Forty-five dogs undergoing pericardiocentesis were prospectively enrolled. Seventeen (37.8%) cases experienced adverse events, with 16 of 45 (35.6%) experiencing an arrhythmia requiring antiarrhythmic therapy during or after pericardiocentesis. There was one case of documented cardiocentesis. No spontaneous death occurred within 48 h. Adverse event occurrence did not differ based on the operator's role (intern, resident, or staff doctor) or the number of pericardiocenteses previously performed by the operator. Supervising operators were present during all pericardiocenteses performed by an intern or an operator who had never performed pericardiocentesis. Neoplasia was documented in 73.3% of cases. Adverse event occurrence was not associated with plasma lactate concentration at presentation or with the presence of neoplasia.

Operator experience level was not associated with adverse event occurrence related to pericardiocentesis. Adverse events were more common than previously reported in the veterinary literature.