A Novel Ultrasound-guided With Needle Visualization Pericardiocentesis Via Subcostal Approach

Abstract Cardiac tamponade is a condition when fluids or blood fill the pericardial space resulting in compression of the heart and subsequently compromising hemodynamic status of the patient. It is a potentially fatal medical or traumatic emergency that requires rapid recognition and immediate treatment. Formerly, blind or surgical techniques were used to aspirate the pericardial fluid and they were associated with plenty of risks and complications. In the recent era, medical technology development has enabled us to perform the procedure safely with the assistance of ultrasound devices. The ultrasound-guided procedure is not only proven to be effective and safe, but it also has very minimal drawbacks and complications. In the literature, there are many ultrasound-guided pericardiocentesis procedures performed with different approaches at different regions. They include subcostal, parasternal, and para-apical approaches and phased array echocardiography transducers are typically preferred for the procedures. We report a case of cardiac tamponade presented with hemodynamic compromise. Ultrasound-guided pericardiocentesis was carried out using in-plane technique with high frequency linear ultrasound transducer at the subcostal region as lifesaving procedure. This particular technique provided full visualization of needle trajectory throughout the procedure. It was successfully completed with no complications and patient’s hemodynamic status improved post-procedure. This article highlights the novel use of in-plane method with high frequency linear transducer at subcostal area as a safe option for pericardiocentesis in patients with cardiac tamponade.