https://www.ctsnet.org/article/subxiphoid-pericardial-window-steps-and-helpful-tips
- A small upper midline incision is made over the xiphoid process.
- The linea alba is incised, exposing the preperitoneal fat, but the peritoneal cavity is not entered.
- The xiphoid process is excised with Mayo scissors, a rongeur, or electrocautery.
- The lower sternum is retracted anteriorly with a Richardson retractor. This will expose the cardiophrenic fat pad and not necessarily the pericardium. Use a small sponge stick or Kittner blunt dissector to sweep the overlying fat pad until the glistening pericardium can be visualized.
- If the preoperative imaging study showed a good amount of fluid collection anteriorly, one can safely use a #15 blade to incise the pericardium. Do not use a #11 blade. Otherwise pick up the pericardium between two forceps
- With drainage, hemodynamic collapse can occur as a result of a diminished preload. It is important to communicate this with anesthesia ahead of time and to administer fluid boluses as necessary.
- Next, grab an edge of the incised pericardium with a artery forceps and excise about an inch and a half of tissue to create the window.
- Use a Yankauer suction tube to probe the pericardial sac and suction out any loculated areas.
- Introduce a drain into the pericardial sac.
- Use a 10 Fr flat JP drain and to direct it posteriorly.
- Finally, close the incision.