For whatever the reason doing anything with the heart sends my own heart rate up. First it was measurements, then doppler work, and that darn aortic outflow in cats! Haha! I was presented with a pericardial effusion echo case today that sent me into anxiety-ville. I am posting the videos here, and as far as stick this amount of effusion it’s probably easy but that first attempt is nerve-racking at best. I mean the heart is literally floating in a pool of effision. The last thing I would want to do is go anywhere near the heart with a pointy shaped object, say a needle?
For whatever the reason doing anything with the heart sends my own heart rate up. First it was measurements, then doppler work, and that darn aortic outflow in cats! Haha! I was presented with a pericardial effusion echo case today that sent me into anxiety-ville. I am posting the videos here, and as far as stick this amount of effusion it’s probably easy but that first attempt is nerve-racking at best. I mean the heart is literally floating in a pool of effision. The last thing I would want to do is go anywhere near the heart with a pointy shaped object, say a needle?
How nervous should one be? I assume the worst case scenario is you end of stabbing the heart and it literally implodes as a nightmarish image on your ultrasound machine of which I would never recover from such an experience, or you possibly nick the heart and virtually nothing happens?
Thx ahead of time for your answers/comments! -chicken little Echotech 🙂
Comments
Oh and I found this on
Oh and I found this on SonoPath under interventional procedures: http://sonopath.com/resources/interventional-procedures/ultrasound-guided-pericardiocentesis I was wondering if this is simliar to other people’s technique for draining pericardial effusion? Thx!
Hi
Don’t worry, its not that
Hi
Don’t worry, its not that difficult. Go from the right side near the apex under ultrasound guidance, then the risk is very low. You can either take a venous catheter and get the whole fluid out or do what I use to do: Just puncture the sac with a relatively thick needle (armed with a syringe to avoid air entering the pleural space) and puncture the sac 10-15 times. What will happen is that the fluid leaves the sac on its own and will enter the pleural space. It won’t cause any troubles there. If possible, save some fluid (2-3 ml) for cytology.
The advantage is: You just need to get the tip of the needle in without any need to leave the needle inside the sac. And you will feel the needle penetrating the pericardium. Still, I would use ultrasound guidance. Secondly, 15 holes wont seal quickly, so the risk of quick recurrance is lower.
Good luck!
Peter
Thx for the information Dr.
Thx for the information Dr. Modler, what size needle or venous cath would you normally would choose for this procedure. Would you use a 6cc syringe to keep the air from entering the body?
I like the idea of puncturing
I like the idea of puncturing the sac 10-15 times -another question regarding this- I assume you do not remove the needle from the chest wall, but rather just pull back slightly and re-orient the needle into a new place on the pericardium?
Should the animal be laterally recumbant or sternal?
Great post,. Thanks for
Great post,. Thanks for asking what I’ve been wanting to ask but wouldn’t dare…
Another conversation for my bookmarked list. Thanks Peter for that option. I never thought of doing that.
I assume you just redirect the needle within the cavity, that’s what I would aim to do.
How long will it take for the fluid in pleural space to tea sorb ( I guess it depends on quantity), and
Hi!
Thanks for this comment!
Hi!
Thanks for this comment! Yes, just re-orient the needle or -more pragmatic- just leave the pericardium and puncture it again.Even if you try to suction all the fluid there will always some fluid end up ib the pleural space – so no difference in terms of risk for metastasis. Basically, I don’t know how long it takes for the pleural space to resorb the fluid. i usually use a 2ccm syringe and – dependent on the size if the dog – a yellow, pink or whire needle (Don’t remember the size 🙂 will have a look once i’m back home). I usually do it in sternal recumbency.
I’m aware that this method has never been published but it workes best in my hands and from my practical perspective….