**4. Post pericardiocentesis management**

Management of patients post percutaneous pericardiocentesis should occur in a specialised cardiac care unit (CCU) at a tertiary level medical centre where possible (**Box 6**). It is a technically challenging life-saving procedure with potential complications.

A chest X-ray (CXR) should be obtained immediately post procedure to exclude an iatrogenic pneumothorax. Regular vital sign recording along with clinical observation should be undertaken to ensure early detection of complications such as haemodynamic collapse, pericardial decompression syndrome or iatrogenic introduction of infection.

Appropriate care of the drainage catheter is essential. The catheter can either be left on continuous free drainage or intermittent aspiration. Intermittent aspiration every 4–6 hours via the three-way valve system is often preferred in clinical practice due to the lower risk of luminal occlusion [25]. The drainage system should be flushed with sterile heparinised saline between aspirations to preserve patency.

The volume of pericardial fluid drained should be recorded at regular intervals. Drainage of greater than 450 mL in the immediate post insertion setting should be avoided due to the higher risk of pericardial decompression syndrome [26].

The drain should be removed when less than 25 mL of fluid is drained in a 24-hour period [25]. Prior to removal an echocardiogram should be performed to ensure


adequate interval echocardiographic improvement. In the event of haemodynamic instability post pericardial drain removal an immediate echocardiogram should be performed to assess for evidence of cardiac tamponade [25].
