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Pericardiocentesis

Pericardial tap; Percutaneous pericardiocentesis; Pericarditis - pericardiocentesis; Pericardial effusion - pericardiocentesis

 

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

How the Test is Performed

 

The procedure is most often done in a special procedure room, such as a cardiac catheterization laboratory. It may also be done at a patient's hospital 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, you may be given medicines if your heartbeat slows or your blood pressure drops during the procedure.

The provider will clean an area just below or next to the breastbone or below the left nipple. Numbing medicine (anesthetic) will be applied to the area.

The doctor will then insert a needle and guide it into tissue that surrounds the heart. Often, echocardiography (ultrasound) is used to help the doctor see the needle and any fluid drainage. An electrocardiogram (ECG) and x-rays (fluoroscopy) 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 tube into containers. Most of the time, the pericardial catheter is left in place so draining may continue for several hours.

Surgical drainage may be needed if the problem is hard to correct or comes back. This is a more invasive procedure in which the pericardium is drained into the peritoneal (abdominal) or chest (pleural) cavity. This may need to be done when you are under general 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 medicine.

 

Why the Test is Performed

 

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

It may also be done to treat cardiac tamponade, which is a life-threatening condition.

 

Normal Results

 

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
  • Renal failure
  • Infection
  • Rupture of a ventricular aneurysm

 

Risks

 

Risks may include:

  • 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)

 

 

References

LeWinter MM, Hopkins WE. Pericardial diseases. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 71.

Little WC, Oh JK. Pericardial diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 77.

 
  • Aneurysm description

    Aneurysm description

    Animation

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    Aneurysm description - Animation

    Common locations of aortic aneurysms, including the abdominal aorta and the thoracic aorta.

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Pericardium

    Pericardium - illustration

    The pericardial sac surrounds and protects the heart within the chest cavity.

    Pericardium

    illustration

  • Aneurysm description

    Animation

  •  

    Aneurysm description - Animation

    Common locations of aortic aneurysms, including the abdominal aorta and the thoracic aorta.

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Pericardium

    Pericardium - illustration

    The pericardial sac surrounds and protects the heart within the chest cavity.

    Pericardium

    illustration

Tests for Pericardiocentesis

 

 

Review Date: 5/5/2016

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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