Ultrasound-Guided Off-Plane Pericardiocentesis via Anterior Approach

This short communication details an innovative ultrasound-guided pericardiocentesis procedure using an off-plane technique via an anterior approach. The method employs a linear transducer and real-time ultrasound guidance to continuously track the needle, enhancing safety and reducing complications associated with traditional techniques, such as pneumothorax, inadvertent cardiac puncture, and injury to the left internal mammary artery (LIMA). The procedure is demonstrated on a 63-year-old patient with malignant pericardial effusion leading to cardiac tamponade. The patient is positioned supine, with head elevation between 30 to 40 degrees. Initial echocardiographic assessment is performed to identify pericardial effusion, particularly in the anterior space between the thoracic wall and the pericardium. Using a low-frequency convex transducer, the distance between the pericardium and the thoracic wall is measured with a high-frequency linear transducer. If the distance exceeds 15 mm, the anterior approach is considered. The location of the LIMA is carefully assessed to avoid inadvertent puncture, with the transducer placed as close to the sternum as possible, and Doppler is used to rule out nearby vessels. Following asepsis, the needle is inserted off-plane and guided in real time, ensuring its trajectory is visible at all stages. The guide, dilator, and catheter are inserted once the needle is in the pericardium. The catheter is then connected to a drainage system to remove the effusion. Post-drainage, an echocardiographic evaluation is conducted to ensure reduction of the effusion and to assess for potential complications, such as pneumothorax. This technique improves the precision of needle placement and minimizes the risks typically associated with pericardiocentesis, offering a safer and more effective alternative to traditional methods.