Pericardiocentesis
Basic Information 
Overview and Goal(s)
To obtain access to the pericardial space for therapeutic and/or diagnostic purposes.
Equipment, Anesthesia
• Sedation will likely be required.
• Pericardiocentesis site preparation: Clippers, scrub material, local anesthetic (eg, 2% lidocaine), needle and syringe for infiltration of the site with local anesthetic, scalpel blade for skin and intercostal muscle incision.
• Large-bore trocar catheter (eg, 16–28 Fr thoracic catheter) or a 10- to 14-gauge over-the-needle catheter if the fluid accumulation is small enough to make large-bore trocar catheter placement dangerous.
• One-way Heimlich valve or condom for the end of the pericardial tube if left indwelling.
Preparation: Important Checkpoints
• An echocardiogram is necassary to determine the optimal location for pericardiocentesis.
• The procedure is usually performed in the left fifth intercostal space approximately 6 cm ventral to the point of the shoulder and dorsal to the lateral thoracic vein.
• The depth of the pericardial fluid (between parietal pericardium and epicardium) should be at least 5 cm to proceed safely with a trocar catheter without risk to the myocardium.
• Continual monitoring by electrocardiography should be performed throughout the procedure.
• An intravenous catheter should be in place before the procedure.
• The size of the pericardial catheter should be as large as can be accomodated by the animal.
Possible Complications and Common Errors to be Avoided
• Arrhythmias, particularly if the epicardium is inadvertently touched with the trocar or catheter.
• Myocardial perforation resulting in hemopericardium and/or fatal hemorrhage.
• Hypotension from fluid shifts if large volumes of fluids are drained quickly without intravenous fluid support.
• Pneumopericardium, pneumothorax, septic pericardium, or septic thorax can be introduced during the procedure.
• Fibrinous effusions can clog the catheter, resulting in the impression that drainage is complete despite a significant volume of fluid remaining.
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