Patients with cardiac tamponade following trauma require an urgent thoracotomy.

If this is not immediately available, pericardiocentesis might be considered as a temporising measure, however it will not address the cause of bleeding and the patient will rapidly destabilise again.


Pericardiocentesis is more typically performed in medical causes of cardiac tamponade.



Traumatic cardiac tamponade and thoracotomy not an immediate option



Pericardial effusion without signs of tamponade and vital signs stable



  • PPE
    • Gown, gloves, mask, eye protection
  • Drapes
  • Antiseptic solution
    • Eg: betadine or chlorhexidine
  • 1% lignocaine 5ml
    • 5ml syringe for LA
    • Drawing up needle
    • 25G needle for skin infiltration, 22G needle for deeper infiltration
  • Pericardiocentesis needle or 18-22G LP cutting needle
  • 20ml syringe and 3 way stop-cock
  • Ultrasound (curvilinear or echo probe) with sterile gel and cover



  1. Ideally patient reclined at 30 degrees
  2. Don PPE
  3. Chosen site is prepped with antiseptic solution and skin infiltrated with local anaesthetic


There are several approaches. Ultrasound guidance is recommended in all cases

The needle is advanced in plane with the operator aspirating the syringe until blood is obtained.


  1. Subxiphoid

The traditionally taught approach

Ultrasound is placed in the subxiphoid position

The needle is inserted between the xiphoid process and left subcostal margin at 45 degrees, aiming up towards the tip of the scapula


  1. Apical

Ultrasound is placed in the apical position

Insert needle at the apex (5th intercostal space, midclavicular line) aiming towards the right shoulder


  1. Parasternal view

Advantage of avoiding the liver and lung but can lacerate the internal mammary artery

Ultrasound is placed in the parasternal long view position

Insert needle adjacent to the probe perpendicular to skin in the 4th or 5th intercostal space just lateral to the sternum



  • Myocardial injury
  • Coronary artery or inferior mammary laceration
  • Precipitation of arrhythmia
  • Liver laceration
  • Pneumothorax

About this guideline

Published: February 2018
Author: Emma Batistich
Updated: April 2021, May 2024 (Nicholas Longley) 
Approved by: Northern Region Trauma Network, Health New Zealand | Te Whatu Ora – Northern Region, NRHL, St. John
Review due: 2 years