Pericardiocentesis is a procedure in which a needle and catheter (small tube) are used to remove fluid from the pericardium – the sac that surrounds the heart. Sometimes fluid can collect inside this sac, a condition called pericardial effusion. When there is a lot of fluid, or if the collection accumulates quickly, it can compress the heart (cardiac tamponade) and prevent it from pumping properly. When this occurs, the fluid must be drained. Sometimes the procedure is done for smaller amounts of fluid to find out what is causing it to collect.
The risk of the procedure is generally low. Complications that can arise include:
- Air accumulation around the lung (pneumothorax) if the needle pokes into the lung. This sometimes requires 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. This sometimes requires 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
Pericardiocentesis is performed to relieve symptoms such as shortness of breath. In some situations, the procedure can be life saving. It can also be used to determine the cause of fluid accumulation (such as infection or other causes). Specimens of the fluid may be sent to a laboratory for testing.
- The doctor will explain the procedure, its risks and benefits, as well as alternatives to you. You will be asked to sign a consent form. This is a good time to make sure all your questions have been answered.
- You will be awake and conscious during the procedure. A mild sedative may be given to help you relax.
- An ultrasound of the heart (echocardiogram) is performed to see where the largest collection of fluid is located.
- Because this is a sterile procedure, your chest will be cleaned with a special solution. Sterile drapes will be spread across your chest leaving an open area where the pericardiocentesis will be performed.
- The doctor will use a small needle to inject a local anesthetic to numb the area where the needle will be introduced.
- The needle, followed by a catheter (a thin, flexible tube), is inserted into your chest through to the pericardial sac. This is often performed using ultrasound guidance.
- The pericardial fluid is drained and samples are usually sent to the laboratory for testing.
- Often, the small tube (catheter) is left in place to allow for further drainage or to ensure that the fluid does not return. This tube will be connected to a drainage system. If this is done, a small stitch is made in the skin to hold the catheter in place and a dressing will be applied. A chest X-ray may be done to make sure no air has leaked into the chest. An ultrasound of the heart (echocardiogram) is often repeated to ensure that the fluid has been successfully removed and is not re-accumulating.
- The doctor will determine when the tube can be removed. When the catheter is removed, a dressing is placed at the puncture site.