Pericardiocentesis
Alan Benheim
John North
A. Definitions
1. Pericardium
a. A double layer of mesothelial lining surrounding the heart, consisting of the visceral pericardium on the epicardial surface and the parietal pericardium as an outer layer
b. The pericardial space, between the visceral and parietal layers, normally has a small amount of pericardial fluid (typically <5 mL for a neonate) that is thought to reduce friction
2. Pneumopericardium
a. Collection of air in the pericardial space
3. Pericardial effusion
a. Accumulation of excess fluid in the pericardial space
4. Pericardiocentesis
a. A procedure to remove air or excess fluid from the pericardial space, usually through a needle, small cannula, or drainage catheter
5. Pericardial drain
a. A catheter or other drainage device left in place to allow intermittent or continuous evacuation of air or fluid from the pericardial space
b. Placed in select situations with recurring accumulation of air or fluid in the pericardial space
 FIGURE 42.1 Pulsus paradoxus. |
6. Tamponade
a. Clinical condition with limited cardiac output because of external restriction of expansion of the heart, preventing normal cardiac filling, resulting in a decreased stroke volume and impaired cardiac output
b. May be caused by:
(1) Fluid or air in the pericardial space
(2) Abnormalities of the pericardium (restrictive or constrictive)
(3) Increased intrathoracic pressure associated with obstructive airway lung disease or tension pneumothorax
7. Pulsus paradoxus (Fig. 42.1)
a. Respiratory variation in blood pressure, with a decrease in systolic blood pressure during spontaneous inspiration. (During positive-pressure ventilation, this is reversed, with a rise in systolic pressure during inspiration.)
b. This finding occurs during tamponade.
B. Background
1. The heart lies within a closed space, covered by the pericardium. The pericardial space is between the two layers of the pericardium. If the pericardial space fills
with excess fluid or if air accumulates, the heart has less space available, and the pressure within the pericardium increases. Increased intrapericardial pressure restricts venous return and impairs cardiac filling. The decrease in venous return and cardiac filling results in a reduced cardiac output. This clinical situation is known as cardiac tamponade (1, 2, 3, 4, 5, 6).
with excess fluid or if air accumulates, the heart has less space available, and the pressure within the pericardium increases. Increased intrapericardial pressure restricts venous return and impairs cardiac filling. The decrease in venous return and cardiac filling results in a reduced cardiac output. This clinical situation is known as cardiac tamponade (1, 2, 3, 4, 5, 6).
2. Neonates are at increased risk for cardiac tamponade when there is:
a. Accumulation of air dissecting into the pericardium from the respiratory system (Fig. 42.2) (4, 5, 7, 8). This risk may be higher for preterm infants whose mothers did not receive prenatal steroids (9).
 FIGURE 42.2 Chest radiograph with pneumopericardium. |
b. Pericardial fluid accumulation due to perforation or transudate from umbilical or central venous catheter (Fig. 34.16, Fig. 42.3) (1, 10, 11, 12, 13, 14)
 FIGURE 42.3 Echocardiogram image of preterm infant with pericardial effusion and central venous line in left atrium. |
f. Cardiac catheterization, either diagnostic or therapeutic (20)
j. Pericardial effusions due to infectious or autoimmune causes (these are less common in neonates than in older children)
3. Clinical symptoms
b. Symptoms may include respiratory distress, hypotension, tachycardia, and/or loss of perfusing rhythm (6, 15).
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