Pericardiocentesis Technique — EECC MCQ

Correct answer: D — Echocardiography-guided subxiphoid approach is preferred — the needle is inserted at a 30-45° angle towards the left shoulder, with continuous echo guidance to avoid cardiac puncture; a pigtail catheter is left for extended drainage if the effusion is likely to reaccumulate

Echo-guided pericardiocentesis per the 2025 ESC Pericarditis Guidelines: (1) approach: subxiphoid (most common — needle enters inferior to the xiphoid process, angled toward left shoulder at 30-45°) or apical (if effusion is predominantly apical on echo); (2) echo guidance is MANDATORY (reduces complications from ~20% blind to <1-2% echo-guided); (3) technique: local anaesthesia → needle aspiration → guidewire → dilator → pigtail catheter placement for extended drainage; (4) send fluid for: cytology, biochemistry (protein, LDH, glucose), microbiology (Gram stain, culture, AFB, TB PCR), and cell count; (5) extended drainage (24-72 hours) reduces reaccumulation; (6) complications: cardiac puncture, pneumothorax, arrhythmia, vasovagal reaction, hepatic/diaphragmatic injury. Surgical pericardial window (subxiphoid or thoracoscopic) is preferred when: (1) loculated effusion; (2) biopsy needed; (3) constrictive component; (4) recurrent effusion despite repeated pericardiocentesis; (5) purulent pericarditis.

Reference: ESC (2025): Myocarditis/Pericarditis Guidelines