Management depends on haemodynamic effects, the cause of tamponade and the characteristics of the effusion.
Indications and technique
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Aspiration: Large effusions causing haemodynamic compromise or cardiac tamponade should undergo aspiration.
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Needle placement: Under echocardiographic guidance, the needle is inserted medial to the cardiac apex or below the xiphoid process and directed upwards towards the left shoulder.
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Route selection: The operator’s experience, the patient’s shape and the position of the effusion determine the route.
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Pericardial drain: A drain may be placed to provide symptomatic relief.
Complications and surgical management
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Procedural complications: Pericardiocentesis can cause arrhythmias, coronary artery damage and bleeding. Injury to the right ventricle can exacerbate tamponade.
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Cardiac rupture or aortic dissection: Emergency surgery is the treatment of choice when either causes tamponade, because aspiration may precipitate further potentially fatal bleeding.
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Effusion characteristics: A viscous, loculated or recurrent effusion may require formal surgical drainage.