Indications
Contraindications
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• A blood dyscrasia in which a patient may have a significant bleeding complication.
• A cutaneous infection in the area of the most feasible sights for pericardiocentesis.
• A significantly elevated diaphragm, a grossly enlarged liver, or profound ascites, which all change the standard landmarks of inserting the pericardiocentesis needle in the subxiphoid area.
• Under such circumstances, use the intercostal approach.
Equipment
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• Povidone-iodine or equivalent sterilization substrate to cleanse the subxiphoid area.
• 1% or 2% lidocaine or xylocaine.
• 25-gauge, 1.5-inch-long needle.
• 16- or 18-gauge needle, ≥ 1.5 inch.
• Floppy tip wire that can be introduced through the needle.
• Pigtail catheter with multiple side holes as well as an end hole.
• Scalpel.
• 3-way stopcock.
• 30-mL or 60-mL syringe and suture kit.
• ECG monitor, pulse oximeter, and blood pressure cuff.
Risks
Pearls and Tips
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• Ideally, a patient should be continuously monitored with echocardiography and fluoroscopy in an interventional radiology or cardiac catheterization laboratory.
• Frequently, this is not an option, and bedside pericardiocentesis without portable fluoroscopy is performed. In this circumstance, the patient should be sedated.
• Respiratory and hemodynamic status should be monitored by assistants, so that the physician can concentrate on performing the pericardiocentesis.

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