Improvement in ultrasonically guided pericardiocentesis

Although two-dimensional echocardiographic guidance, combined with contrast studies, represents a substantial advancement in performing pericardiocentesis, limitations still exist concerning posteriorly loculated pericardial effusions. Subxyphoid pericardiotomy is often required in these cases. We tested the use of the Tuohy needle, under ultrasound control, with the specific purpose of improving posterior drainage. The bent tip of this needle, in fact, was expected to facilitate positioning of the drainage catheter in the posterior pericardial space. This method was utilized in 20 cases with loculated posterior (11 patients) or diffuse (9 patients) pericardial effusion. We failed in only 1 case who presented tight posterior pericardial adhesions. The drainage was successful and complete in 19 cases. No complications occurred. This study shows that the combined use of an appropriate two-dimensional ultrasound monitoring with the Tuohy needle greatly facilitates catheter guidance to the posterior pericardial space.