Pericardiocentesis
Pericardiocentesis, also known as pericardial tap or percutaneous pericardiocentesis, is a medical procedure that involves the insertion of a needle or catheter into the pericardium, the membrane surrounding the heart, to drain excess fluid. This procedure is primarily performed to alleviate fluid buildup, which can impede the heart's ability to pump effectively, especially in urgent cases of cardiac tamponade, where rapid fluid accumulation poses a life-threatening risk. It can also serve a diagnostic purpose in cases of suspected metastatic cancer.
Prior to the procedure, patients undergo several tests, including an electrocardiogram and echocardiogram, and fasting is required. During the procedure, local anesthesia is administered, and a needle is guided into the pericardium using imaging technology. If a significant amount of fluid is present, a catheter may be placed for continuous drainage. Afterward, patients are monitored for any complications, with a hospital stay ranging from overnight to a few days. While generally safe, pericardiocentesis carries potential risks, including infection and arrhythmias. The results of the fluid analysis can provide critical insights into underlying health conditions, particularly in the context of cancer diagnosis.
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Subject Terms
Pericardiocentesis
ALSO KNOWN AS: Pericardial tap, percutaneous pericardiocentesis
DEFINITION: Pericardiocentesis involves inserting a needle or catheter through the pericardium, the membrane surrounding the heart, to drain excess fluid.
Cancers diagnosed or treated:Mesothelioma and other lung cancers, advanced breast cancer, lymphoma, melanoma, leukemia
Why performed: Pericardiocentesis is primarily a therapeutic but sometimes a diagnostic procedure. It removes excess fluid from the pericardium that is inhibiting the heart’s pumping action. If this pericardial effusion has accumulated rapidly, causing a life-threatening condition known as cardiac tamponade, then the procedure is performed on an emergency basis to avoid sudden death. In cases of suspected metastatic cancer, fluid buildup requires both relief and pathology.
Patient preparation: A few days before the procedure, an electrocardiogram (EKG), an echocardiogram, and blood tests confirm that the operation is safe. Patients must not eat or drink for several hours beforehand.
Steps of the procedure: Nonemergency pericardiocentesis is scheduled in a hospital. An intravenous (IV) line is inserted in the patient’s arm or hand for medications. The puncture site is sterilized, and a local anesthetic is given. With the patient’s head elevated 30 to 60 degrees, the physician, guided by an image on a video monitor, inserts a needle beneath the breastbone and into the pericardium. When enough fluid has been removed, the needle is withdrawn, and direct pressure is applied. Large accumulations of fluid require the insertion of a catheter through which the fluid can drain into a bag. Extreme cases require general anesthesia and open surgery.
After the procedure: The patient stays in an intensive care unit while vital signs, the incision site, and fluid drainage are monitored. Nurses watch for bulging of the jugular vein in the neck, which suggests problems with blood flow. The length of the hospital stay may be as short as overnight or as long as a few days.
Percutaneous pericardiocentesis is a procedure that, along with pericardial pericardiocentesis with extended catheter drainage, has shown to be successful in almost 100 percent of cases in which cancer patients underwent pericardiocentesis. Further, treating patients with anti-inflammatory medications, such as prednisolone and colchicine, reduced the likelihood of serious complications including cardiac tamponade.
Risks: With guided imaging, pericardiocentesis is relatively safe, with a 5 to 40 percent risk of these side effects: air embolism (air in a blood vessel, blocking blood flow); infection of the pericardial membranes (pericarditis) or at the incision site; irregular heartbeat (arrhythmia); heart attack (myocardial infarction); pneumopericardium (introduction of air into the pericardial sac); and puncture of the heart muscle (myocardium), stomach, lungs, liver, or a coronary artery.
Results: Normal pericardial fluid is clear, straw-colored, and low in viscosity. High viscosity, low clarity, and the presence of blood, bacteria, abnormal cells, high levels of protein, or an excessive number of white blood cells indicate an abnormal result. The latter three conditions particularly suggest the spread of cancer to the pericardium, which is confirmed with biopsy and pathology.
Bibliography
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