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Communications to the Editor |

What To Do When Bloody Fluid Is Obtained on Pericardiocentesis? FREE TO VIEW

Tsung O. Cheng, MD, FCCP
Author and Funding Information

The George Washington University Washington, DC

Correspondence to: Tsung O. Cheng, MD, FCCP, Professor of Medicine, The George Washington University Medical Center, 2150 Pennsylvania Avenue, NW, Washington, DC 20037



Chest. 2000;117(5):1525-1526. doi:10.1378/chest.117.5.1525-a
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To the Editor:

The excellent article from the Mayo Clinic group,1 in which Tsang et al reviewed their 19 years of experience with echocardiographically (echo-) guided pericardiocentesis, proves that echocardiography is useful not only for diagnosis of pericardial effusion but also for management of pericardiocentesis. These authors concluded that echo-guided pericardiocentesis is simple, safe, and effective for primary treatment of clinically significant pericardial effusion.

The authors mentioned that, when bloody fluid was encountered during the procedure, agitated saline contrast material should be injected to confirm the position of the needle. There is a simpler and faster method to determine if the pericardiocentesis needle is in the pericardial space or in the intracardiac chamber, when echocardiography is not readily available, especially in emergency situations.

For the past 45 years, I have always included an ampule of dehydrocholate and an ampule of lobeline on the sterile pericardiocentesis tray.23 If blood or bloody fluid is obtained on pericardiocentesis, dehydrocholate, or lobeline in the case of an obtunded patient, should be injected through the aspirating needle. If the patient gives a typical response, as in an ordinary circulation time determination, the needle is in a cardiac chamber and should be withdrawn immediately. If there is no response from the patient, the needle must then be in the proper pericardial space, and aspiration of bloody fluid can be continued with impunity. In parts of the world where dehydrocholate might not be readily available, magnesium sulfate might be substituted.4

References

Tsang, TS, Barnes, ME, Hayes, SN, et al (1999) Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979–1998.Chest116,322-331
 
Cheng, TO Ventricle or pericardial space? Ann Intern Med. 1973;;78 ,.:461
 
Cheng, TO Pointers on pericardiocentesis. Cathet Cardiovasc Diagn. 1989;;17 ,.:67
 
Cheng, TO Contrast echocardiography during pericardiocentesis.Heart1999;82,534-535
 

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References

Tsang, TS, Barnes, ME, Hayes, SN, et al (1999) Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979–1998.Chest116,322-331
 
Cheng, TO Ventricle or pericardial space? Ann Intern Med. 1973;;78 ,.:461
 
Cheng, TO Pointers on pericardiocentesis. Cathet Cardiovasc Diagn. 1989;;17 ,.:67
 
Cheng, TO Contrast echocardiography during pericardiocentesis.Heart1999;82,534-535
 
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