These are the indications for pericardiocentesis:

Potential complications of the pericardial puncture include visceral perforation, pneumothorax, haemothorax, coronary artery laceration and cardiac perforation (the inferior vena cava, right atrium, right or even left ventricle). Arrhythmias may occur, as well as transient hypotension and low cardiac output.

There is no absolute contraindication for pericardiocentesis in acute cardiac tamponade, but a variety of conditions may increase the risk of the procedure. Do realize that surgical drainage may be a superior alternative in some instances. Special caution should be taken in case of a traumatic bleed, bleeding diatheses and suspected purulent effusion. A small or posteriorly located effusion is difficult to reach, and if multiple septa are present, a simple puncture is likely to fail.

If in adults tamponade or haemopericardium is associated with aortic dissection, emergency surgery is the only reliable approach.

In a nonurgent procedure, the patient and/or parents should be informed about the procedure and possible complications, and give consent.

Depending on local practice, the pericardiocentesis is performed either in the ICU or in the cath lab, with echo standby. Patient’s ECG, heart rate, blood pressure and oxygen saturation are monitored continuously. The echo machine should be running and pericardiocentesis package prepared.