Robin Lester's ICU Trivia

Question #1

Q: Where would your needle insertion be if you were...

Just a bit of "trivia" to see how many of you still remember your anatomy.  There are two different schools of thought when performing a pericardial centesis.  It can be done from either the left or right side but do you know why one might prefer to tap from the right side of the chest as opposed to the left? (hint: what could you possibly hit or lacerate when tapping from the left side)

Question #2

Q: Do you know what kind of quick and easy test can be performed to determine if the bloody fluid you tapped is truly from the pericardial sack or if it is directly from the heart?

***Scroll Down to the Botton of the Page to Find Out the Answers***

Question #1

A: Needle insertion for...

Question #2

A: The test that can be performed to check if the fluid you aspirated was from the pericardial sack or directly from the heart is called a "clot" test. Very simple. Place a sample in a red top tube. If it clots then you have blood directly from the heart...if it doesn't clot, you have successfully tapped the pericardium. You can also compare your fluid against a PCV of peripheral blood....."hopefully" your PCV will be higher. (ie: it should be higher or you're probably going to need a blood transfusion very quickly)!

One other helpful thing to check when doing a pericardial centesis...check the pH of the fluid with either a urine dipstick or litmus paper. A pH < 7 is consistent with an inflammatory process and a pH >7 is suggestive of neoplasia.

An Extra Thought...

Just to mention a few things....whenever you tap any kind of fluid from the chest (or abdomen for that matter), you should save some of the fluid in a large red-top vacutainer tube, a purple-top vacutainer tube as well as a small red-top tube for culture and sensitivity. It would also be wise to make a few slides of the aspirate as well and if the fluid is bloody to spin it down in a hematocrit tube and get a PCV reading on it. Like I said earlier, you hope it is less than that of the peripheral circulation.