> Procedural Ultrasound: Cardiac Procedures
Procedural Ultrasound

Cardiac Procedures

Pericardiocentesis


Mayo Clinic experience: “Ideal entry” point in 211 cases

sensor position
  • 173 para-apical
  • 12 left parasternal
  • 12 left axillary
  • 11 right parasternal
  • 3 posterolateral
  • Subcostal in 29 cases

parasternal



subxiphoid

Narration

So pericardiocentesis is hopefully an infrequent procedure in the emergency setting, but it can certainly be aided with ultrasound guidance. Typically it is taught to do this procedure blindly from a subxyphoid approach, but the thing to understand with this is getting to the pericardial sac through the liver can involve going through a lot of tissue and what has been found when you use ultrasound guidance you can find places where the skin is close to that pericardial fluid collection and in a large series from the Mayo Clinic they found that the majority of cases - over 80% - where in the periapical approach next to the apex of the heart they found a very short distance from skin to effusion and this was the preferred access route.


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