Page 1022 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Cardiovascular system 997

VetBooks.ir Table 8.5 Techniques for performing pericardiocentesis

• Cardiac tamponade
Indications
• Guide therapy (culture, cytology)
Contraindications • Small amount of fluid (risk of cardiac/coronary laceration)
• If echogenic pleural fluid present (risk of contamination of pericardial space)
Adverse effects • Vessel laceration (thoracic or coronary) may lead to death
• Ventricular ectopy if epicardium contacted
• Extension of infection from pleural space
Cautions • Pericardiocentesis without ultrasound guidance should be performed with great caution
• Left side preferred due to lower risk of coronary artery laceration
• Indwelling drains risk ascending infection and pneumopericardium
Equipment • Ultrasound machine (optimal)
• 10–12-gauge intravenous catheter
• Alternatively, small-bore chest tube (if large volume)
Location • 5th ICS on the left side (right side only if large volume of fluid present, due to increased risk of coronary
artery laceration)
• Variable level, between costochondral junction and shoulder
• Avoid lateral thoracic vein
Technique • Surgical preparation
• Local anaesthetic
• Scalpel incision – size dependent on catheter choice
• Gentle force needed to penetrate thoracic cavity
• One hand used to advance catheter
• Stabilise catheter with second hand near skin to control depth of advancement
• Advance catheter cautiously until slight pop detected or fluid aspirated
• Sudden loss of resistance as catheter enters thoracic cavity/pericardium necessitates controlled
advancement to avoid laceration
• Allow fluid to drain
• Aspirate with caution – risk of myocardial contact
• Avoid pneumopericardium by use of one-way valve
• Indwelling drain possible

cool extremities and prolonged CRT. Intermittent Management
pyrexia may be present. There are few therapeutic options. Supportive ther-
apy, particularly pericardiocentesis, may provide
Differential diagnosis short-term improvement.
Bacterial, viral or idiopathic pericarditis, pleural effu-
sion and other intrathoracic neoplasia may be similar. Prognosis
The prognosis is poor, and euthanasia is often
Diagnosis indicated.
The diagnostic process is similar to that described
for pericarditis. Echocardiography and cytological HEART FAILURE
examination of pericardial fluid are the most impor-
tant components. Identification of neoplastic cells in Definition/overview
pericardial effusion is diagnostic. Haematological Horses have a large cardiac reserve and overt heart
changes are variable and non-specific. Decreased failure is uncommon; however, occasional car-
QRS amplitude may be present on the ECG if sig- diac diseases cases will progress to this over time.
nificant pericardial effusion is present. Heart failure is the inability of the heart to pump