Author + information
- Nils Petri1,
- Babett Ertel1,
- Tobias Gassenmaier1,
- Björn Lengenfelder1,
- Thorsten Bley1 and
- Wolfram Voelker1
“Blind” pericardiocentesis is the standard procedure for emergency pericardial drainage when ultrasound guidance is unavailable. Under these circumstances puncture site and needle direction have to be exclusively oriented according to certain anatomic landmarks. In the literature, different techniques for this “blind” method have been described. Goal of this retrospective study was to compare the success and complication rate of 13 different puncture directions.
Simulated pericardiocentesis were performed in 150 CT scans from patients with moderate to severe pericardial effusions (> 1 cm). For comparison of the 13 different puncture techniques, the puncture site, the direction of the puncture and the inclination were varied. A pericardiocentesis was classified as “successful” when the effusion was reached without penetrating adjacent structures (lung, liver, internal thoracic artery, LAD, colon and stomach).
A subxiphoidal approach starting in the sternocostal triangle and directed towards the left mid clavicle-point with a 30° inclination resulted in the highest success rate (131 of 150 cases= 87.3%). In parallel the lowest complication rate (7 of 150) occurred using this technique, as well (n=3: lung; n=2: liver; n=1: colon; n=1: LAD).
This CT-based simulation study revealed that “blind” pericardiocentesis is best performed in a subxiphoid approach with a needle direction to the left mid clavicle point with a 30° inclination. Furthermore, this technique produced the lowest rate of complications. Nevertheless, injury of adjacent structures was still significant (4.7%).