Pericardiocentesis

Pericardiocentesis involves the use of a needle to withdraw fluid from the pericardial sac (membrane that surrounds the heart).

In the past this procedure was performed in a cardiac catheterization laboratory, but now it is usually performed in the procedure room of an intensive care unit, or even at the bedside.

An IV line is inserted in case fluids or medications need to be given. Medication may be given to prevent vasovagal reflex resulting in bradycardia (a slowing of the heartbeat) and hypotension (drop in blood pressure).

The insertion site just below the breastbone (sternum) will be cleansed, and a local anesthetic will be given. A pericardiocentesis needle will then be inserted and guided into the pericardial sac. Electrocardiographic (ECG) leads may be attached by a clip to the needle to help with proper needle positioning. However, echocardiography is more frequently used to help position the needle and monitor drainage.

Once the needle has reached the pericardial sac, a guide wire is inserted. The needle is removed and replaced with a catheter. The fluid is withdrawn through this catheter and put into containers. Usually this pericardial catheter is left in place to continue the draining for several hours.

Surgical pericardiocentesis may be necessary in difficult cases. In this procedure, the fluid is drained through a more invasive procedure that may require anesthesia.

If the test is elective, you will not be able to eat or drink for 6 hours before the test. You must sign a consent form.

You may feel pressure as the needle enters. Some people feel transient chest pain, which may require pain medication.

This test may be performed to remove fluid that is compressing the heart for examination. It is usually done to evaluate the cause of a chronic or recurrent pericardial effusion (fluid in the pericardial sac). It may also be done as a treatment measure to relieve cardiac tamponade (compression of the heart from an accumulation of fluid within the pericardial sac).

There is normally a small amount of clear, straw-colored fluid in the pericardial space.

Abnormal findings may indicate the cause of pericardial fluid accumulation, such as:

• Cardiac perforation
• Pericarditis
• Congestive heart failure
• Cancer
• Cardiac trauma
• Rupture of a ventricular aneurysm (stretching and bulging of a weakened ventricular wall)

• Puncture of the heart muscle (myocardium) or a coronary artery (vessel that supplies blood to the heart muscle)
• Pneumopericardium (air in the pericardial sac)
• Heart attack
• Irregular heartbeats arrhythmias
• Infection (pericarditis)
• Puncture of the lung, liver, or stomach