Pericardiocentesis

(Also called: pericardial tap)

Purpose

Pericardiocentesis is a procedure in which a needle is used to remove fluid from the sac, or pericardium, that surrounds the heart. Sometimes fluid can collect inside this bag (pericardial effusion). When there is a lot of fluid, it can press on the heart (pericardial tamponade) and prevent it from pumping properly. When this occurs, the fluid must be drained immediately. Sometimes the procedure is done for smaller amounts of fluid to see what is causing the collection of fluid.

Description

1. The physician explains the procedure and risks to the patient and asks for informed consent.
2. An ultrasound of the heart (echocardiogram) is performed to see where the largest collection of fluid is located.
3. Under sterile conditions, the chest is cleaned and cloth drapes are spread around the chest leaving an open region where the pericardiocentesis is to be performed.
4. Local anesthetic is injected into the skin to numb a small area.
5. A needle is inserted into the chest and into the pericardial sac.
6. The pericardial fluid is drained and samples are sent to a laboratory for testing.
7. Sometimes a small tube (catheter) is inserted to allow for further drainage over a few days. If this is done, a small stitch is made in the skin to hold the catheter in place.
8. When the needle or catheter is removed, a bandage is placed at the needle-puncture site.
9. A chest X-ray is done to make sure that no air leaked into the chest, and sometimes the ultrasound of the heart (echocardiogram) is repeated to see that the fluid is draining well.

Risks

There is very little risk of complications, including:

• Air leaking around the lung (pneumothorax) if the needle pokes into the lung, sometimes requiring a tube (catheter) to be inserted into the chest to allow the air to escape
• Irregular heart rhythms from the needle or catheter touching the heart
• Bleeding if the needle pokes into the heart or a blood vessel, sometimes requiring surgery to repair it
• Infection around the heart from where the needle went in
• Damage to a nerve if it is poked by the needle