The pericardial sac surrounds the heart. It normally contains a small amount of fluid. Pericardiocentesis is the withdrawal of fluid from this sac with a needle.
Pericardiocentesis may be used as a treatment. If too much fluid builds up in the sac, this can put extra pressure on the heart. This is known as cardiac tamponade . It is a life-threatening condition. Withdrawing some of the fluid will help to relieve the pressure on the heart.
Pericardiocentesis may also be used to diagnose the cause of fluid build up. Fluid build up is known as pericardial effusion. The build up can be caused by an infection, cancer, trauma, autoimmune disorders, or drug use . It may also indicate the presence of rheumatoid arthritis , heart attack , or kidney failure .
If you are planning to have a pericardiocentesis, your doctor will review a list of possible complications, which may include:
Factors that may increase the risk of complications include:
Pericardiocentesis may be a scheduled or emergency procedure. This can have an impact on which tests are done prior to the procedure. The following tests may be conducted prior to your procedure:
Leading up to your procedure:
Light sedation will be given to help you relax. You will be awake during the procedure. A local anesthesia will be injected at the insertion site. It will numb an area on your chest.
You will lie on a table. An IV line will be inserted into your arm. The sedative will be delivered this way. The area where the needle will be inserted will be washed. Your heart will be monitored.
The needle will be inserted into the chest. It will be slowly moved toward the heart. Ultrasound and possibly fluoroscopy will be used to help guide the needle to the correct location. The needle will be passed into the pericardial sac, but no further.
Once in the pericardial sac, the fluid will be removed. The needle may be used, or a catheter tube may be inserted over the needle. After some fluid is collected or enough of the fluid has drained out, the needle or catheter will be removed. Pressure will be applied to the injection site for several minutes. This is done to stop the bleeding.
In some cases, your doctor may leave the catheter in place. This will allow draining to continue over several hours or days.
You will have a chest x-ray to make sure your lung has not been punctured. You will be closely monitored for several hours after the procedure. Your pulse, blood pressure, and breathing will be checked regularly.
The fluid removed from the pericardial sac is sent to a lab to be analyzed.
About 20-60 minutes
You may feel pain when the needle is inserted.
Hospital stay can vary from one day to several days. If the catheter remains in place to continue draining fluid, you may need to stay in the hospital several days.
When you return home, do the following to help ensure a smooth recovery:
After you leave the hospital, contact your doctor if any of the following occurs:
In case of an emergency, CALL 911.
RESOURCES:
American Heart Association
http://www.americanheart.org/
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca/
Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/splash/
References:
Brockman RG, Ziskind AA. Pericardiocentesis and associated treatment of pericardial effusion. Cardiac Intensive Care. 1998;657-663.
Ferri FF. Ferri’s Clinical Advisor: Instant Diagnosis and Treatment. Philadelphia, PA: Mosby; 2006.
Pericardiocentesis (pericardial tap). Cleveland Clinic Heart Center website. Available at: http://www.clevelandclinic.org/heartcenter/pub/guide/tests/procedures/pericardiocentesis.htm. Accessed September 16, 2005.
Pericardium and pericarditis. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4683. Accessed September 25, 2005.
Protocol cardiac: pericardiocentesis. Vanderbilt University Medical Center website. Available at: http://www.mc.vanderbilt.edu/lifeflight/web/protocol/3i.htm. Accessed September 16, 2005.
Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, PA: Saunders: Elsevier; 2004.
Spodick DH. Acute cardiac tamponade. New England Journal of Medicine. 2003;349:684-690.
Tibbles CD, Porcaro W. Procedural applications of ultrasound. Emergency Medicine Clinics of North America. 2004;22:797-815.
Last reviewed November 2009 by Craig Clark, DO, FACC, FAHA, FASE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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