Thursday March 19, 2009

Scenario: 47 year old male admitted from cardiac cath. lab after insertion of pericardial catheter with drainage bag. Patient is hemodynamically stable. Few hours later nurse reported that blood in pericardial bag appears more 'darker' and 'bloody'. Describe various methods to rule out ventricular punture by pericardial catheter?

Answer: There could be various laboratory and non-laboratory methods to rule out ventricular punture by pericardial catheter.

1. Though not always true but pure pericardial fluid usually does not clot.

2. Decholin test - Inject 3 ml of Sodium dehydrocholate (Decholin) in pericardial catheter. If patient complains of bitter taste within few minutes - ventricular rupture is likely.

3. Fluorescein test - Inject Fluorescein in pericardial catheter and look for fluorescent 'flush' under ultraviolet light beneath the skin of the eyelid. If visible - ventricular rupture is likely.

4. Draw hematocrit from venous blood and compare with pericardial hematocrit. Same values of hematocrit make ventricular rupture highly likely.

5. Draw ABG from venous blood and compare with pericardial ABG. PO2 is usually lower and PCO2 is usually higher in pericardial fluid. Same values in ABGs make ventricular rupture likely.