Tamponade with hemodynamic compromise requires urgent removal of the pericardial fluid. Pericardial fluid removal may be accomplished via catheter pericardiocentesis or surgical drainage. Percutaneous pericardial drainage usually is accomplished with echocardiographic or fluoroscopic guidance using a subxiphoid approach. Surgical drainage typically is reserved for those patients in whom percutaneous drainage was unsuccessful, the pericardial fluid is loculated, if there is a need for biopsy material, or for recurrent accumulation. Percutaneous balloon pericardiotomy has been used in a number of institutions for recurrent malignant effusions. While preparing the patient for pericardiocentesis, cautious fluid resuscitation and inotropic support may be used. Volume depletion with diuretics and positive pressure ventilation should be avoided at all costs.
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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