Pericardiocentesis practice in the United Kingdom

Balmain, S., Hawkins, N.M., MacDonald, M.R., Dunn, F.G. and Petrie, M.C. (2008) Pericardiocentesis practice in the United Kingdom. International Journal of Clinical Practice, 62(10), pp. 1515-1519. (doi:10.1111/j.1742-1241.2007.01536.x) (PMID:18036168)

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Abstract

Background:  Pericardial effusions frequently present challenging clinical dilemmas. Whether or not to drain an effusion, and if so by what method, are two common decisions facing cardiologists. We performed a survey to evaluate pericardiocentesis practice in the United Kingdom (UK). Methods:  A total of 640 questionnaires were sent to all cardiologists in the UK Directory of Cardiology in March 2003. Results:  A total of 274 (43%) completed questionnaires were returned, 88% from consultants, equally distributed between tertiary referral centres and district general hospitals. More than 1500 procedures were performed, largely using a paraxiphoid approach (89%). Clinical tamponade was the commonest indication for pericardiocentesis (83%). However, the majority of respondents (69%) considered echocardiographic features alone an indication for pericardiocentesis, even in the absence of clinical tamponade. The commonest perceived indications for drainage were right ventricular diastolic collapse and right atrial collapse (69% and 33% of respondents respectively). For guidance, 82% use echocardiography, either alone or with fluoroscopy or the electrocardiogram (ECG) injury trace. 11% employ fluoroscopy alone or with the ECG injury trace. The remaining 11% stated that they would use the ECG injury trace alone or use no guidance. Using the ECG injury trace alone is said by the European Society of Cardiology (ESC) guidelines to offer an inadequate safeguard. Reported complications included ventricular puncture (n = 12, 0.8%) and hepatic damage (n = 4, 0.3%). Conclusion:  Pericardiocentesis practice varies substantially in the UK. Many cardiologists would perform pericardiocentesis based on echocardiographic features alone. 11% of cardiologists use guidance that is considered inadequate by the ESC guidelines.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Petrie, Professor Mark
Authors: Balmain, S., Hawkins, N.M., MacDonald, M.R., Dunn, F.G., and Petrie, M.C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:International Journal of Clinical Practice
Publisher:Wiley
ISSN:1368-5031
ISSN (Online):1742-1241
Published Online:23 November 2007

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