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Pericardiocentesis

Definition

Pericardiocentesis is a procedure that uses a needle to remove fluid from the pericardial sac, the tissue that surrounds the heart.

Alternative Names

Pericardial tap; Percutaneous pericardiocentesis

How the test is performed

The procedure is usually done in an intensive care unit's procedure room or even at the bedside.

A health care provider will put an IV into your arm in case fluids or medicines need to be given through a vein. For example, medication may be given if you have slowing of the heartbeat or a drop in blood pressure during the procedure.

The health care provider will clean an area just below the breastbone and apply a local numbing medication (anesthetic). The doctor will insert a needle and guide it into the pericardial sac. Echocardiography is used to help position the needle and monitor fluid drainage, although electrocardiographic (ECG) leads may also be used to help with positioning.

Once the needle has reached the correct area, it is removed and replaced with a tube called a catheter. Fluid drains through this catheter into containers. Usually, the pericardial catheter is left in place so draining may continue 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.

How to prepare for the test

You may not be able to eat or drink for 6 hours before the test. You must sign a consent form.

How the test will feel

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

Why the test is performed

This test may be done to remove and examine fluid that is pressing on the heart. It is usually done to evaluate the cause of a chronic or recurrent pericardial effusion.

It may also be done to treat cardiac tamponade.

Normal Values

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

What abnormal results mean

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

• Cancer
• Cardiac perforation
• Cardiac trauma
• Congestive heart failure
• Pericarditis
• Rupture of a ventricular aneurysm

What the risks are

• Bleeding
• Collapsed lung
• Heart attack
• Infection (pericarditis)
• Irregular heartbeats (arrhythmias)
• Puncture of the heart muscle, coronary artery, lung, liver, or stomach
• Pneumopericardium (air in the pericardial sac)

Special considerations

References

LeWinter MM. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 70.