Chapter 39 ■ Pericardiocentesis 277

4. Draining a large volume from the pericardial space can

alter cardiac preloading conditions significantly, and

some infants may benefit from intravascular fluid

boluses after the pericardium is drained.

5. Pericardiocentesis is often an urgent or emergency procedure. The technique for pericardiocentesis described

above applies when there is time for each step. In an

infant with significant hemodynamic compromise, the

operator may be forced to omit certain steps in the interest of time. This requires a judgment as to the baby’s clinical status and the time delay involved for any given step,

such as waiting for the ultrasound machine, preparing a

larger sterile field, or assembling a three-way stopcock system. In extreme cases, this life-saving procedure might

consist of pouring or swabbing Betadine over the subxiphoid area, followed by “blind” aspiration using any available needle and syringe, without anesthetic, and before

any other equipment is available at the bedside (15).

K. Complications (15–17,20,21)

1. Pneumopericardium

2. Pneumomediastinum

3. Pneumothorax

4. Cardiac perforation

5. Arrhythmia

6. Hypotension (if a large effusion is drained)

References

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2. Tsang TS, Barnes ME, Hayes SN, et al. Clinical and echocardiographic characteristics of significant pericardial effusions following

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associated with large pericardial effusions in pediatric patients by

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Pediatr Scand. 1990;79:234.

8. Ramasethu J. Complications of vascular catheters in the neonatal

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