Pericardiocentesis

Published on 22/03/2015 by admin

Filed under Critical Care Medicine

Last modified 22/03/2015

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W9 Pericardiocentesis

image Before Procedure

Indications

Pericardial effusion without hemodynamic compromise:

image Anatomy

The pericardium is a fibroserous sac that contains the heart and the origin of the main vessels. It is composed of a fibrous outer layer and an inner serous membrane consisting of a single layer of mesothelial cells. The pericardial space normally contains 25 to 50 mL of fluid in adults. If the amount of fluid increases, the pericardium is not immediately distensible, even though stress relaxation may occur within minutes from the beginning of the increase in pericardial pressure. If the fluid accumulates slowly over weeks or months, the pericardium can increase in size to a maximum capacity of 1 to 2 L. The heart, and therefore the pericardium, is located at the center of the mediastinum, partially covered by the lungs, sternum, costal cartilages of the third, fourth, and fifth ribs, and by the intercostal muscles. About two-thirds of the heart is located on the left side of the chest. The heart rests on the diaphragm. The pericardium is innervated by the vagus nerve, the left recurrent laryngeal nerve, the esophageal plexus, and it also has rich sympathetic innervation from the stellate and first dorsal ganglia and the cardiac, aortic, and diaphragmatic plexuses. When performing pericardiocentesis, close attention should be paid to avoid damaging the internal thoracic artery, which runs behind the sternal end of the costal cartilages, and the vascular bundle at the inferior margin of each rib (Figure W9-1).