DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
INDICATION
Drain a pericardial effusion only if there is cardiovascular compromise. If time allows, discuss with paediatric cardiologist before drainage
PERICARDIAL EFFUSION
Common causes
- Neonatal hydrops
- Extravasation of fluids from migrated long lines
Clincal signs
- Sudden collapse in baby with long line or umbilical venous catheter in situ – always consider pericardial tamponade
- Tachycardia
- Poor perfusion
- Soft/muffled heart sounds
- Cardiomegaly
- Decreasing SpO2
- Arrhythmias
Investigations
- Chest X-ray: widened mediastinum and enlarged cardiac shadow
- Echocardiogram
EQUIPMENT
- Sterile gown and gloves
- Sterile drapes
- Dressing pack with swabs and plastic dish
- 22/24 G cannula
- 5–10 mL syringe with 3-way tap attached
- Cleaning solution as per unit policy
- Lidocaine
PROCEDURE
Consent and preparation
- If time allows, inform parents and obtain consent (verbal or written)
- If skilled operator available, perform under ultrasound guidance
- In an emergency situation, the most experienced person present performs procedure without delay and without ultrasound guidance
- Ensure baby has adequate analgesia with IV morphine and local lidocaine instillation
Drainage
- Maintain strict aseptic technique throughout
- Clean skin around xiphisternum and allow to dry
- Infiltrate with local anaesthetic and wait for it to work
- Attach needle to syringe and insert just below xiphisternum at 30° to skin and aiming toward left shoulder
- Continuously aspirate syringe with gentle pressure as needle is inserted. As needle enters pericardial space there will be a gush of fluid, blood or air
- Send aspirated fluid for microbiological and biochemical analysis
- Withdraw needle
AFTERCARE
- Cover entry site with clear dressing (e.g. Tegaderm™/Opsite)
- Discuss further management with paediatric cardiologist