• 
  

  • Therapeutic: Impending cardiac tamponade.

  
  

  • Diagnostic.

  
  
  
  
  • 
    

    • Infectious pericarditis.

    
    

    • Rule out an oncologic process.

  
  

  • Compromise in the patient’s hemodynamic status.

Relative

• 
  

  • 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.

• 
  

  • 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.

• 
  

  • Infection and bleeding can be minimized with proper technique.

  
  

  • Pneumothorax (unusual).

  
  

  • Laceration of the liver (unusual).

  
  

  • Coronary injury (unusual).

  
  

  • Cardiac perforation (unusual).

• 
  

  • 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.