274 Section VII ■ Tube Replacement

3. Clinical signs of cardiac tamponade may evolve gradually or rapidly (1,3,18).

4. The primary therapy for cardiac tamponade is to evacuate the pericardial space. Volume expansion and pressor agents may be of transient benefit, but they usually

do not result in sustained clinical improvement

(1,8,12,16,19).

5. Cardiac tamponade may require urgent treatment with

pericardiocentesis in infants with severe hemodynamic

compromise (1,16,17).

D. Indications (1,12,15–17)

1. Cardiac tamponade due to pneumopericardium

2. Cardiac tamponade due to pericardial fluid

3. Aspiration of pericardial fluid for diagnostic studies

E. Contraindications

1. There are no absolute contraindications to performing

pericardiocentesis in the setting of cardiac tamponade.

2. Relative contraindication for diagnostic pericardiocentesis

a. Coagulopathy

b. Active infection. (However, infection may also be an

indication for diagnostic pericardiocentesis in some

clinical situations.)

F. Precautions

Draining a large volume from the pericardial space can

alter cardiac preloading conditions significantly, and some

infants may require a supplemental intravascular fluid

bolus after the pericardium is drained.

G. Limitations

1. Cannot readily evacuate thrombus

2. Cannot remove mass lesions

H. Equipment

Sterile

1. Antiseptic solution

2. Aperture drape or multiple drapes to be arranged

around access site

Fig. 39.2. Chest radiograph with pneumopericardium.

CVL, crossing into left atrium

Central venous catheter crossing atrial septum.

*-pericardial effusion, RA - right atrium, LA - left atrium,

 RV - right ventricle, LV - left ventricle.

RA LA

RV LV

Fig. 39.3. Echocardiogram image of preterm infant with pericardial effusion and central venous line in left atrium.

Blood pressure

Inspiration Expiration Inspiration Expiration Fig. 39.1. Pulsus paradoxus.