Page 315 - Clinical Small Animal Internal Medicine

(a) (b)

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(c) (d)

(e) (f)

Figure 28.6 Pericardiocentesis in a dog. This dog had a history of biting and no clinical signs of dyspnea. A muzzle was placed as a
precautionary measure along with gentle restraint for the procedure. (a) Identify the ideal position for introducing the catheter into the thorax,
which is often around the fifth or sixth intercostal space near the costochondral junction. It can be found by flexing the right front limb and
swinging the leg across the thorax and using the intercostal space where the point of the elbow crosses the costochondral junction.
(b) Locating the ideal site for catheter entry using ultrasound guidance. (c) Following sterile preparation of the pericardiocentesis site, inject a
local anesthetic block into the skin, intercostal muscles, and pleura. After approximately five minutes, use a scalpel blade to make a small stab
incision in the skin to facilitate catheter insertion and advancement. Note multiple spots were marked on the perimeter of the shaved area to
triangulate the position for the anesthetic block and subsequent catheter entry site. (d) At the predetermined ideal pericardiocentesis site,
advance the catheter through the skin, followed by the intercostal muscles, avoiding the caudal aspect of the rib where the intercostal
vessels are located, and into the pleural space. Note the leads have been attached for monitoring the electrocardiogram during the procedure.
(e) The catheter was advanced until a scratching sensation was detected when the needle contacted the pericardium. Once pericardial effusion
was encountered, the extension set tubing was detached from the needle, the needle removed from the catheter, and the extension set tubing
reattached directly to the catheter. Removing the needle prevents contact with the heart as the pericardial fluid is removed. (f) Two extension
sets are connected with a three‐way stopcock. One extension set tubing is connected to the end of the catheter and the second is emptying
into a collection bowl. Note the fluid is hemorrhagic in appearance, characteristic of pericardial effusion.