Pericardiocentesis can be nasty!
Pericardiocentesis is a challenging procedure, not uncommonly associated with iatrogenic complications. Pneumothorax, epicardial coronary vasculature injury, injury to intracardiac structures and valves, chamber puncture and great vessel injury or perforation, air embolism, and puncture of the peritoneal cavity or abdominal viscera have all been reported at the hands of unwary clinicians.

In the case published in the Annals of Cardiac Anesthesiology, a planned therapeutic pericardiocentesis ended up with a pigtail inadvertently threaded into the main pulmonary artery. Transesophageal echocardiography showed introducer sheath puncturing the right ventricular (RV) free wall and the pig tail catheter rail roaded into the main pulmonary artery, both of which had to be surgically extracted after sternotomy.

Risk factors that predict difficulty in performing pericardiocentesis must be readily identified and use of adjunctive imaging is sine qua non for patient safety during the procedure. Morbidity associated with such dreaded complications is completely avoidable with an insight into the possibility of their occurrence and appropriate use of the available technology.

Read in detail about the case here: