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In pericardiocentesis, a needle is inserted through the chest and into the pericardium (the sac that surrounds the heart muscle) to withdraw fluid from the pericardial sac. Pericardiocentesis is used both diagnostically and therapeutically. Pericardiocentesis is done to diagnose the cause or presence of pericardial effusion (fluid build-up in the pericardium). Pericardial effusion can occur for many reasons including infection, cancer, trauma, autoimmune disorders, and drug use. Cardiac tamponade, which is life threatening, is the compression of the heart muscle due to fluid accumulation in the pericardium. This is an emergency and pericardiocentesis is performed to relieve the pressure by removing the excess fluid.
Pericardiocentesis may be a scheduled procedure or an 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:
- Blood tests
- Chest x-rays—a test that uses radiation to take a picture of structures inside the body, especially bones
- Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
- Echocardiogram—a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
The day before and the day of your procedure:
- You will need to restrict your intake of fluid and food prior to your procedure. Your doctor or nurse will give you specific instructions.
- If you are diabetic, ask your doctor how to adjust your medications for the procedure.
- You may need to adjust other medications you are taking.
- Make sure you tell your physician all the medications (prescription and over-the-counter) that you are taking.
Light sedation to help you relax, but you will be awake and conscious during the procedure. You will lie on an operating table with your chest elevated at a 30°-45° angle if possible. This is to bring the heart closer to the chest wall and to help with draining. An intravenous line will be inserted into your arm to administer a sedative that will help you relax. The area where the needle will be inserted will be washed with an antiseptic and if necessary, shaved. A local anesthesia will be injected at the insertion site to numb an area on your chest. Your heart will be monitored with an ECG. Your doctor will insert the needle at a 45° angle into the chest and slowly move it towards the heart. He or she will use ultrasound or echocardiogram to help guide the needle to the correct location. Once at the pericardium, your doctor will advance the needle into the pericardial sac but no further (about 6-8 centimeters [cm] below the skin in adults and 5 cm or less in children). Once in the pericardial sac, your doctor will remove the fluid using the needle or insert a catheter to remove the fluid. After the needle or catheter is 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 to 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. You may feel pain when the needle penetrates the pericardium. - Needle damage to an organ, such as lung, coronary vessel, myocardium, aorta, inferior vena cava, or esophagus
- Venous air embolism due to air entering the heart
- Infection (pericarditis)
- Disruption on the heart’s normal rhythm (dysrhythmia)
Hospital stay can vary from one day to several days. Typically, you will stay overnight. If the catheter remains in place to continue draining fluid, you may stay in the hospital several days.
When you return home, do the following to help ensure a smooth recovery:
- Clean the injection site daily with lukewarm water and sensitive soap like Cetaphil. Do not scrub the area.
- Avoid vigorous activities, especially those involving the upper body, until your physician says that you can resume them.
- Return to work and regular daily activities as soon as you are ready; sexual relations may resume as soon as you are able.
- Make and keep all postoperative appointments.
The fluid removed from the pericardial sac is sent to a lab to be analyzed. Abnormal test results could be caused by many different things, including infection, cancer,
rheumatoid arthritis,
heart attack, or
kidney failure. If you have abnormal test results, your physician will determine the treatment option that works best for your situation.
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Chest pain or signs of a heart attack
- Shortness of breath or difficulty breathing
- Vomiting
- Dizziness
Last reviewed November 2007 by J. Peter Oettgen, MD 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. Copyright © EBSCO Publishing. All rights reserved. |
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