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Clark ST, Alten JA, Borasino S, Hock KM, Law MA. Comparison of PLANE Technique versus Standard Echocardiography Guidance for Pediatric Pericardiocentesis. J Pediatr Intensive Care 2024; 13:32-36. [PMID: 38571979 PMCID: PMC10987214 DOI: 10.1055/s-0041-1736213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022] Open
Abstract
Percutaneous pericardiocentesis remains a challenging and potentially dangerous procedure, particularly in small, critically ill patients. We present outcomes of the PLANE (pericardiocentesis using long-axis in-plane real-time echocardiography) technique for pediatric pericardiocentesis compared with a standard echocardiography (ECHO) guidance cohort. This was a retrospective chart review of all children undergoing percutaneous pericardiocentesis from March 2013 to February 2021 at a single center. A total of 78 procedures were performed, 52 utilizing PLANE technique and 26 utilizing standard ECHO-guidance technique. There was 100% technical success rate with only one minor complication for the entire cohort. Procedures were evenly split between the bedside intensive care unit and cardiac catheterization laboratory. PLANE technique was utilized in significantly younger (1.4 vs. 8.4 years, p = 0.008) and smaller (11.1 vs. 31.8 kg, p = 0.007) patients, as well as in most patients deemed high risk (postoperative < 7 days, extracorporeal membrane oxygenation (ECMO) support, and/or weight less than 5 kg; 19/22, p = 0.021). Other patient characteristics were similar between the two groups. There was a trend toward PLANE technique utilization by noncardiology trained operators. The PLANE technique for pediatric pericardiocentesis is safe and effective and can be effectively utilized in small and high-risk patient populations. The technical similarity to other long-axis ultrasound-guided procedures may facilitate adoption and mastery by critical care trained operators.
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Affiliation(s)
- Stephen T. Clark
- Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jeffrey A. Alten
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Santiago Borasino
- Division of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Kristal M. Hock
- Division of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Mark A. Law
- Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Mohammed NA, Al-Zubairi TA, Al-Soumai MH. A case report on ultrasound-guided pericardiocentesis with a right parasternal approach: a novel in-plane lateral-to-medial technique. Int J Emerg Med 2024; 17:15. [PMID: 38302868 PMCID: PMC10835824 DOI: 10.1186/s12245-024-00592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/26/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Emergency pericardiocentesis is a life-saving procedure that is performed to aspirate fluid from the pericardial space in patients who have severe pericardial effusion that is causing hemodynamic compromise. The current gold standard for pericardial fluid aspiration is ultrasound-guided pericardiocentesis. Echocardiography with a low-frequency transducer has generally been used in pericardiocentesis, but this method lacks real-time visualization of the needle trajectory, leading to complications. Therefore, we describe a case involving an ultrasound-guided pericardiocentesis method using a novel in-plane technique with a lateral-to-medial approach via the right parasternal and a high-frequency probe. The method was performed for an infant with cardiac tamponade. CASE PRESENTATION We present a case of a 14-month-old male infant who was brought to the emergency room with a history of cough, shortness of breath, and fever following recurrent chest infections. Despite prior treatments, his condition deteriorated, and signs of cardiac tamponade were evident upon examination. Cardiopulmonary point-of-care ultrasound confirmed the presence of a large pericardial effusion with tamponade. Emergency pericardiocentesis was performed using the novel in-plane technique, resulting in successful fluid aspiration and stabilization of the patient's condition. TECHNIQUE DESCRIPTION The proposed technique involves positioning a high-frequency ultrasound probe over the right parasternal area to obtain real-time visualization of the needle trajectory and surrounding structures, including the sternum, right internal thoracic vessels, pleural sliding end point, pericardial effusion, and myocardium. The needle is inserted laterally to medially at a 45-degree angle, ensuring safe passage between the pleural sliding endpoint and the right internal thoracic vessels while reaching the pericardial effusion. CONCLUSION The presented technique provides real-time visualization of the needle and surrounding structures, which may potentially help to avoid complications and improve accuracy. The proposed technique may potentially enable access for emergency pericardiocentesis and for loculated pericardial effusion that has formed around the right atrium. Nevertheless, further studies with large patient populations are needed.
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Affiliation(s)
- Najem Abdullah Mohammed
- Emergency Department and Intensive Care Unit, Al Zamalh Hospital, Mawia Street, Taiz City, Yemen.
- Faculty of Medicine and Health Sciences, Taiz University, Habeel Street, Taiz, Yemen.
- POCUS Academy, Sana'a City, Yemen.
| | - Tanweer A Al-Zubairi
- Emergency Department and Intensive Care Unit, Al Zamalh Hospital, Mawia Street, Taiz City, Yemen
- Faculty of Medicine and Health Sciences, Taiz University, Habeel Street, Taiz, Yemen
| | - Moad H Al-Soumai
- Emergency Department and Intensive Care Unit, Al Zamalh Hospital, Mawia Street, Taiz City, Yemen
- Faculty of Medicine and Health Sciences, Taiz University, Habeel Street, Taiz, Yemen
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Perks A, Brendt P. Pericardiocentesis for COVID-19 Associated Cardiac Tamponade Using a Central Venous Catheter in Rural Australia: A Case Report. Air Med J 2024; 43:63-65. [PMID: 38154844 DOI: 10.1016/j.amj.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 12/30/2023]
Abstract
Pericardiocentesis is a high-acuity, low-occurrence procedure rarely performed by emergency and retrieval clinicians. We present a case of cardiac tamponade secondary to coronavirus disease 2019 managed with prehospital pericardiocentesis in remote Australia, 800 km from the nearest hospital. This was performed using a quadruple-lumen central venous catheter. The procedure significantly improved the patient's clinical state, enabling a safe transfer via fixed wing aircraft to a tertiary center. In this report, we highlight that the ability to diagnose cardiac tamponade in coronavirus disease 2019-positive patients and perform pericardiocentesis under point-of-care ultrasound guidance can be lifesaving.
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Affiliation(s)
- Angus Perks
- Royal Flying Doctors Service South Eastern Section, Surry Hills, New South Wales, Australia.
| | - Peter Brendt
- Royal Flying Doctors Service South Eastern Section, Surry Hills, New South Wales, Australia
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Paladini A, D'Andrea V, Bottoni A, Purcaro V, Prontera G, Costa S, Vento G. Ultrasound-guided diagnostic pericardiocentesis in preterm infants: a case report. J Matern Fetal Neonatal Med 2023; 36:2212831. [PMID: 37188355 DOI: 10.1080/14767058.2023.2212831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Pericardial effusion (PE) in pediatric population can be asymptomatic or a life-threatening event. Reports on neonates or preterm infants are scarce and generally related to pericardiocentesis of large amounts of PE in emergency situations.We describe a diagnostic pericardiocentesis in a preterm infant with small and loculated pericardial effusion and suspected cardiac mass. We used an ultrasound-guided long-axis in-plane pericardiocentesis technique, with a needle-cannula. The operator obtained a subxiphoid pericardial effusion view with a high frequency linear probe and entered the skin below the tip of the xiphoid process with a 20-gauge closed IV needle-cannula (ViaValve®). The needle was identified in its entirety as it courses through soft tissue up to pericardial sac. The main advantages of this approach are a continuous viewing and angulation of the needle through all planes of the tissue and the use of a small, practical, closed IV needle-cannula with blood control septum to prevent fluid exposure while disconnecting the syringe. This novel approach is easy and safe in neonatal population, for diagnostic or emergency drainages and can be performed at bedside in a neonatal intensive care unit.
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Affiliation(s)
- Angela Paladini
- U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vito D'Andrea
- U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anthea Bottoni
- U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Velia Purcaro
- U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgia Prontera
- U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simonetta Costa
- U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- U.O.C. di Neonatologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, Rome, Italy
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Zhang L, Zhang XF, Liu Z, Liu Y, Guo CL, Shao H, Li B, Zhang C, Jing H, Cheng W. High frequency ultrasound-guided pericardiocentesis performed in the sitting position: A novel apical approach. Clin Cardiol 2021; 44:1106-1112. [PMID: 34101857 PMCID: PMC8364732 DOI: 10.1002/clc.23657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 12/26/2022] Open
Abstract
Background So far, few approaches have been described to reduce inadvertent injury to structure of the heart and nearby organs in percutaneous pericardiocentesis. Hypothesis We hypothesized that an in‐plane high frequency ultrasound‐guided apical approach, performed in the sitting position, would provide additional benefits in terms of feasibility and safety for draining malignant pericardial effusion (MPE). Methods The authors selected 53 consecutive patients with moderate or large symptomatic MPE who underwent high frequency ultrasound‐guided pericardiocentesis. After the procedure, all patients were followed for 90 days with the main purpose of detecting procedure success, procedure‐related complications, and recurrent PE. Results Procedure success rate for pericardiocentesis was 100%. All patients were placed in the sitting position with their left hands extended above the heads. An apical puncture approach was performed in all cases (100%). The mean duration of catheter drainage was 8.1 ± 3.2 days. The mean initial amount of pericardial fluid drained was 956.3 ± 687.5 ml. Overall, six patients (11%) had recurrent PE; 3 (6%) had repeated percutaneous pericardiocentesis. There was no major complication and minor complications occurred in four patients (8%). Conclusion This novel in‐plane high frequency US‐guided apical approach has several advantages for percutaneous pericardiocentesis of MPE: performed in the sitting position; a benefit for patients with orthopnea; a maximum inserted wide angle to prevent damage to the myocardium; local enlargement of the PE region; high procedure success rate of pericardiocentesis; and excellent clinical outcomes.
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Affiliation(s)
- Lei Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.,Interventional Ultrasound Ward, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xue-Fei Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.,Interventional Ultrasound Ward, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhao Liu
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ying Liu
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cun-Li Guo
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hua Shao
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Bo Li
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cui Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hui Jing
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.,Interventional Ultrasound Ward, Harbin Medical University Cancer Hospital, Harbin, China
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