Safety and efficacy of inserting double-lumen catheter under echo guidance for pericardial fluid tapping

Abstract

Background and Objectives: The aim of the article is to determine safety and efficacy of echocardiography (ECHO) guided pericardiocentesis at a quaternary care hospital. Cardiac tamponade is a life threatening condition which requires urgent pericardiocentesis. The pericardium has the ability to stretch and accommodate fluid but when the intra pericardial pressure becomes equal to right atrial pressure, the right ventricle collapses and hypotension occurs. Echocardiography guided pericardiocentesis is a useful technique. Methodology: We describe the echo guided drainage of cardiac tamponade done on emergency basis using central venous catheter (CVC). Subxiphoid approach was done in all the cases. The approximate distance from skin to pericardial fluid was mapped. Echo guided needle insertion was done. The fluid was aspirated and guide wire was inserted. The guide wire position in pericardial space was confirmed using echocardiography. The procedure was continued as per the Seldinger technique. Results: A total of twenty two patients underwent 24 procedures in a two year period. The procedure, outcomes and complications are discussed. The central venous catheter was inserted in 12 males and 10 females.. The fluid was straw colored in 14 cases, purulent in 5 and hemorrhagic in 3 cases. The age group ranged between 2 years to 14 years while the mean age was 7 years. The mean duration of central venous catheter placement was 48 hours. The procedural success rate was 100%. Conclusion and Interpretation: It was possible to perform the entire procedure in the pediatric intensive care unit (PICU) in all the cases without the need to shift to cardiac catheterization laboratory. Pericardial catheter insertion using CVC under echo guidance is a safe and effective technique for management of pericardial effusion.