Pericardiocentesis Health Article

Definition

Pericardiocentesis is the removal by needle of pericardial fluid from the sac surrounding the heart for diagnostic or therapeutic purposes.

Purpose

The pericardium, the sac (or membrane) that surrounds the heart muscle, normally contains a small amount of fluid that cushions and lubricates the heart as the heart expands and contracts. When too much fluid gathers in the pericardial cavity, the space between the pericardium and the outer layers of the heart, a condition known as pericardial effusion occurs. Abnormal amounts of fluid may result from:

• pericarditis (caused by infection, inflammation)
• trauma (producing blood in the pericardial sac)
• surgery or other invasive procedures performed on the heart
• cancer (producing malignant effusions)
• myocardial infarction, congestive heart failure
• renal failure

Possible causes of pericarditis include chest trauma, systemic infection (bacterial, viral, or fungal), myocardial infarction (heart attack), or tuberculosis. When pericarditis is suspected, pericardiocentesis may be advisable in order to obtain a fluid sample for laboratory analysis to identify the underlying cause of the condition.

Pericardiocentesis is also used in emergency situations to remove excessive accumulations of blood or fluid from the pericardial sac, such as with cardiac tamponade. When fluid builds up too rapidly or excessively in the pericardial cavity, the resulting compression on the heart impairs the pumping action of the vascular system. Cardiac tamponade is a life-threatening condition that requires immediate treatment.

Precautions

Whenever possible, an echocardiogram (ultrasound test) should be performed to confirm the presence of the pericardial effusion and to guide the pericardiocentesis needle during the procedure. Because of the risk of accidental puncture to major arteries or organs in pericardiocentesis, surgical drainage may be a preferred treatment option for pericardial effusion in non-emergency situations.

Description

The patient's vital signs are monitored throughout the procedure, and an ECG tracing is continuously run. If time allows, sedation is administered, the puncture site is cleaned with an antiseptic iodine solution, and a local anesthetic is injected into the skin to numb the area. The patient is instructed to remain still. The physician performing pericardiocentesis will insert a syringe with an attached cardiac needle slowly into the chest wall until the needle tip reaches the pericardial sac. The patient may experience a sensation of pressure as the needle enters the membrane. When the needle is in the correct position, the physician will aspirate, or withdraw, fluid from the pericardial sac.

When the procedure is performed for diagnostic purposes, the fluid will be collected into specimen tubes for laboratory analysis. If the pericardiocentesis is performed to treat a cardiac tamponade or other significant fluid build-up, a pericardial catheter may be attached to the needle to allow for continuous drainage.

After the cardiac needle is removed, pressure is applied to the puncture site for approximately five minutes, and the site is then bandaged.