step-by-step pericardiocentesis guide for dogs

 Alright — here’s your step-by-step pericardiocentesis guide for dogs so you’ve got it ready when a tamponade patient comes through the door.

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Pericardiocentesis in Dogs – Quick Emergency Protocol

⚠ Goal: Relieve cardiac tamponade by draining pericardial fluid safely and quickly.
📌 Golden rule: This is both diagnostic and life-saving — do NOT delay for full work-up if the patient is crashing.

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1. Equipment

• Sterile gloves, clippers, surgical scrub

• 14–18G over-the-needle catheter (small dogs: 16–18G; large dogs: 14–16G)

• Extension tubing + 3-way stopcock + large syringe (20–60 mL)

• Collection tubes (EDTA, plain, culture)

• Local anesthetic (lidocaine) + syringes + needles

• ECG monitoring (strongly recommended)

• Oxygen supply

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2. Patient Preparation

• Place in right lateral recumbency → approach from the right side (avoids coronary artery that runs on left).

• Clip from 3rd to 8th intercostal space and from sternum up to halfway up thorax.

• Provide oxygen supplementation.

• Place IV catheter for fluid support.

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3. Sedation / Restraint

• Many dogs with tamponade are too unstable for heavy sedation.

• If needed: low-dose butorphanol ± midazolam for mild anxiolysis.

• Avoid drugs causing vasodilation or negative inotropy (e.g., acepromazine, high-dose alpha-2s).

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4. Site Selection

• Usually 4th–6th intercostal space, just ventral to costochondral junction on the right thorax.

• Mark spot cranial to the rib (vessels & nerves run caudal to rib).

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5. Aseptic Preparation

• Scrub and drape the area thoroughly — infection here can be catastrophic.

• Local infiltration with lidocaine at the chosen site down to pleura.

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6. Procedure

1. Attach catheter → extension tubing → 3-way stopcock → syringe.

2. Insert needle bevel up, angled slightly toward the heart.

3. Advance slowly while aspirating gently until fluid enters tubing.

4. Advance catheter into pericardial space, withdraw stylet.

5. Drain as much fluid as tolerated (often 100–500 mL or more).

6. Watch ECG — ventricular arrhythmias may occur if you touch the myocardium; if they persist, withdraw slightly.

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7. Aftercare

• Save samples for cytology, culture, biochem.

• Monitor heart rate, rhythm, and respiratory status.

• Repeat echo within hours to days to check for recurrence.

• Discuss long-term plan with owner (possible recurrence, surgery, prognosis based on cause).

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8. Tips & Tricks

• Right-sided approach: safer for avoiding coronary artery.

• Don’t over-sedate: collapsing patient needs preload maintained.

• If blood is aspirated and it clots → you’ve hit the heart, not pericardium. Withdraw and redirect.

• Pericardial blood from neoplasia/trauma won’t clot in syringe (due to defibrillation).

• Ultrasound guidance greatly increases safety — especially if effusion is small.

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