Why should the patient be positioned at 45 60 degrees angle during pericardiocentesis?

A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. If it develops over a chronic period of time, the pericardium can dilate to accommodate the fluid. However, if it occurs acutely, rapid hemodynamic compromise ensues due to cardiac compression. Causes of pericardial effusion can be acute, subacute, or chronic. Indications for pericardiocentesis include therapeutic, diagnostic, or palliative. Informed consent should be obtained as there are several well-described risks. The procedure should be performed on telemetry, with appropriate intravenous access and supplemental oxygen, and under sterile precautions whenever possible. Ultrasound guidance is also recommended.

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Author information

Authors and Affiliations

  1. Division of Trauma, Emergency Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA

    Meghan Lewis & Subarna Biswas

  2. Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA, USA

    David Shavelle

Authors

  1. Meghan Lewis

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  2. Subarna Biswas

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  3. David Shavelle

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Corresponding author

Correspondence to Meghan Lewis .

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Southern California, Los Angeles, CA, USA

    Demetrios Demetriades

  2. Department of Surgery, University of Southern California, Los Angeles, CA, USA

    Dr. Kenji Inaba

  3. Department of Anethesiology, University of Southern California, Los Angeles, CA, USA

    Prof. Philip D. Lumb

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Lewis, M., Biswas, S., Shavelle, D. [2018]. Pericardiocentesis. In: Demetriades, D., Inaba, K., Lumb, P. [eds] Atlas of Critical Care Procedures . Springer, Cham. //doi.org/10.1007/978-3-319-78367-3_16

What is the pericardiocentesis position?

The patient undergoing pericardiocentesis is positioned supine with the head of the bed raised between a 30 and 60 degree angle. This places the heart in proximity to the chest wall for easier insertion of the needle into the pericardial sac.

Which patient position is best for assessment of pericardial effusion?

The patient should be supine with the HOB slightly elevated. The left lateral decubitus position may improve your visualization as well.

What is the best location to place a needle into the chest to perform pericardiocentesis?

The needle insertion site is in the fifth left intercostal space close to the sternal margin. Advance the needle perpendicular to the skin [at the level of the cardiac notch of the left lung].

For what common complication of performing a pericardiocentesis should the nurse assess the patient?

Potential complications of pericardiocentesis include ventricular puncture, cardiac arrest, pneumothorax, liver laceration, laceration of a coronary artery or vein, pericardial tamponade, bleeding, and ventricular and atrial arrhythmias.

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