Pericardiocentesis

Procedures & Monitoring · ICU Decoded chapter 84 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to ESC pericardial guidance.

Key points

Diagnose tamponade clinically and on echo: RA/RV diastolic collapse, plethoric IVC, and pulsus paradoxus.
Use an echo-guided subxiphoid or apical approach; draining even 50–100 mL restores output.
Avoid in aortic dissection (surgery instead); hemopericardium/trauma gets a surgical window.
Send fluid for cells, protein, Gram/culture, cytology; leave a drain if it recurs.

Investigations

First tests: Bedside echocardiography, 12-lead ECG, Full blood count.

Only if indicated: PT/INR, aPTT and fibrinogen, Pericardial fluid tests.

Repeat monitoring: Bedside echocardiography.

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