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The Echo Manual

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CHAPTER 12 PERICARDIAL DISEASES

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FIGURE 12-11 (See Video A and B) Echocardiographically guided pericardiocentesis (Video 12-5). Step 1. Locate an area on the chest or subcostal region from which the largest amount of pericardial effusion can be visualized and mark it ( A – C ). Step 2. Determine the depth of effusion from the marked position and the optimal angulation. Step 3. After sterile preparation and local anesthesia, perform pericardiocen- tesis ( D ). Step 4. When in doubt about the location of the needle, inject saline solution through the needle and image it from a remote site to locate the bubbles. Step 5. Monitor the completeness of the pericardiocentesis with repeat echocardiography. Step 6. Place a 6F or 7F pigtail catheter in the pericardial space to minimize reac- cumulation of fluid ( E ). Step 7. Drain any residual fluid or fluid that has reaccumulated via the pigtail catheter every 4–6 hours. If after 2–3 days pericardial fluid has not reac- cumulated, as seen in echocardiographically, the pigtail catheter may be removed. Always have the pericardial fluid analyzed: cell counts, glucose and protein measurements, culture, and cytology. (Modified from Callahan JA, Seward JB, Tajik AJ, et al. Pericardiocentesis assisted by two-dimensional echocardiography. Journal of Thoracic and Cardiovascular Surgery, 1983:85:877–879, used with permission.)

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