Abstract
Pericardial effusion is a potentially lethal condition. If it is discovered early, it can be treated by pericardiocentesis under controlled condition with imaging by experienced care providers. If it is diagnosed at a later stage with clinical compromise, then an emergent procedure might be necessary. Since it is encountered infrequently, many providers may have little or no experience in managing the condition and performing a life-saving pericardiocentesis.This is a technical report that describes the creation of a neonatal model for pericardiocentesis. This is a high-fidelity, low-cost model that is simple to create. Materials that are inexpensive and easy to obtain are utilized to make the model. Neonatal care providers, including residents, fellows, nurse practitioners, physician assistants, and attendings, can practice with this model. In some medical centers, an echocardiogram or bedside ultrasound is available to guide needle insertion; however, practicing the procedure on a model provides valuable experience. This model is designed to teach the performance of unguided pericardiocentesis without the use of simultaneous imaging.Included with this technical report are a supply list, a checklist, and a suggested scenario that can be used in association with this model. In this article, we have discussed our own experience and described lessons learned about training neonatal care providers in pericardiocentesis.
Highlights
Cardiac tamponade is a catastrophic event for any patient
If the condition being treated is a pneumopericardium, once the syringe is full of air, the syringe is evacuated by operating the three-way stopcock to allow its release and repositioning the valve to close the system and more air is removed
Cardiac tamponade is a catastrophic event, and if not immediately treated, the patient will progress to cardiac arrest and likely die
Summary
Cardiac tamponade is a catastrophic event for any patient. Newborn babies, both full term or pre-term, can experience cardiac tamponade as a result of an air leak syndrome [1] or as a complication from a central venous catheter with leakage of fluids or infusate (blood and total parenteral nutrition [TPN]) [2] into the pericardial space, among other causes. The glove is filled with 15-20 cc of the simulated body fluid or TPN, and the wrist area is tied off, removing as much air as possible (Figure 1). This model has removable skin, and the chest cavity can be accessed after removing the arms that are affixed to the shoulders with a screw-type mechanism. The simulated heart is secured in the chest cavity with adhesive tape; the removable plastic rib cage is placed on top; the skin is replaced; and the arms are reattached to the manikin. Oxygen saturations: 75%; HR: 50 bpm Electrocardiogram: Small QRS complexes consistent with low voltage
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