Videos

Join Now

How to perform a pericardiocentesis in a dog | VETgirl Veterinary Continuing Education Videos

Stop procrastinating and join VETgirl! Get clinically relevant CE on your time.

Join Now

Need Help?

In this VETgirl online veterinary continuing education video, we demonstrate how to perform a pericardiocentesis in a dog with pericardial effusion secondary to lymphosarcoma. In this dog, the presence of pericardial effusion was confirmed on initial ultrasound (e.g., T-FAST, echocardiogram). An intravenous catheter was placed, and the patient was stabilized with oxygen and appropriate monitoring (e.g., blood pressure, ECG).

To perform a pericardiocentesis, light sedation is typically necessary. A cardiovascularly-sparing protocol should be used (e.g., butorphanol or fentanyl and midazolam or diazepam, etc.). Sterile technique and ECG monitoring is imperative. The appropriate supplies should be prepared in advanced:

  • Appropriately-sized pericardiocentesis or “centesis” catheter
  • ECG
  • Pre-drawn lidocaine (dosed appropriately) in the event of an emergency
  • Oxygen supplementation
  • A three-way stopcock or one-way valve
  • A 12-, 20- or 60- ml syringe (based on patient size)
  • An EDTA tube for fluid analysis
  • A red top tube for possible culture (rarely done) and to confirm if the sample clots or not (alternatively an ACT tube can be used)

Depending on clinician preference, pericardiocentesis can be performed on the left or ride side (VETgirl prefers the right side (e.g., left lateral recumbency) to avoid puncture of the lung (via the cardiac notch). An over-the-needle catheter system (typically 16 gauge, 1.5 to 4 inches, depending on the size of the patient) can be used, with extra small side holes placed into the catheter to facilitate flow during pericardiocentesis. After the catheter is advanced and the stylet removed, extension tubing is directly attached (along with a three-way stopcock and syringe).

Typically, pericardial effusion is very hemorrhagic in appearance. If so, a small amount of blood should be placed into a red top tube to look for presence of a clot (This is bad. This means you hit the heart. Slowly back out and keep calm. Non-clotting blood is consistent with blood present in the pericardial sac that has already undergone fibrinolysis (This is good. It means you can continue to aspirate during your pericardiocentesis). In this dog, the pericardial effusion was atypical in appearance (e.g., modified transudate, with fluid analysis revealing lymphosarcoma), warranting submission for fluid analysis/cytology (Check out this VETgirl podcast here on why you need to check the PCV stat!). Once pericardial effusion has been removed, an ultrasound (e.g., T-FAST, echocardiogram) can be used to confirm improvement or resolution of the pericardial effusion.

For more information, check out our other VETgirl videos here.

References:
1. MacGregor JM, Faria ML, Moore AS, et al. Cardiac lymphoma and pericardial effusion in dogs: 12 cases (1994-2004). J Am Vet Med Assoc 2005;227(9):1449-53.

2. Sims CS, Tobias AH, Hayden DW, et al. Pericardial Effusion Due to Primary Cardiac Lymphosarcoma in a Dog. J Vet Intern Med 2003;17:923–927.

Only VETgirl members can leave comments. Sign In or Join VETgirl now!