Drain a pericardial effusion only if there is cardiovascular compromise. If time allows, discuss with paediatric cardiologist before drainage

Common causes

• Neonatal hydrops
• Extravasation of fluids from migrated long lines

Clincal signs

• Sudden collapse in baby with long line or umbilical venous catheter in situ – always consider pericardial tamponade
• Tachycardia
• Poor perfusion
• Soft/muffled heart sounds
• Cardiomegaly 
• Decreasing SpO₂
• Arrhythmias

Investigations

• Chest X-ray: widened mediastinum and enlarged cardiac shadow
• Echocardiogram 

• Sterile gown and gloves
• Sterile drapes
• Dressing pack with swabs and plastic dish
• 22/24 G cannula
• 5–10 mL syringe with 3-way tap attached
• Cleaning solution as per unit policy
• Lidocaine

Consent and preparation

• If time allows, inform parents and obtain consent (verbal or written) 
• If skilled operator available, perform under ultrasound guidance
• In an emergency situation, the most experienced person present performs procedure without delay and without ultrasound guidance
• Ensure baby has adequate analgesia with IV morphine and local lidocaine instillation

Drainage

• Maintain strict aseptic technique throughout
• Clean skin around xiphisternum and allow to dry 
• Infiltrate with local anaesthetic and wait for it to work
• Attach needle to syringe and insert just below xiphisternum at 30° to skin and aiming toward left shoulder
• Continuously aspirate syringe with gentle pressure as needle is inserted. As needle enters pericardial space there will be a gush of fluid, blood or air
• Send aspirated fluid for microbiological and biochemical analysis
• Withdraw needle

• Cover entry site with clear dressing (e.g. Tegaderm™/Opsite)
• Discuss further management with paediatric cardiologist