Pericardiocentesis – Procedure, Purpose, and Results

Overview

When a person’s heart accumulates excess fluid in the pericardium – the sac that surrounds the heart – the fluid must be drained. The process of draining the fluid is known as Pericardiocentesis. The procedure could save a patient’s life if the patient suffers from excess fluid in the pericardium and cardiac tamponade (the heart does not have space to function normally).

This blog is a comprehensive guide to understand Pericardiocentesis, its procedure, purpose, and results.

What is Pericardiocentesis?

Pericardiocentesis is a procedure that drains the excess fluid in the pericardium. The pericardium is a sac-like membrane found around the heart. The doctor drains the fluid in the sac using a needle and a catheter.

What factors contribute to the need for Pericardiocentesis?

The fluid build-up around the heart causes shortness of breath and chest pain. Sometimes, the fluid accumulates even after medications, leading to a life-threatening disease. Therefore, the doctor drains the fluid at the earliest through Pericardiocentesis. The procedure can also assist in determining the source of the excess fluid. Pericardium gets filled with fluid (pericardial effusion) due to a variety of factors, including:

• Infection of the heart or pericardial sac
• Cancer
• Inflammation of the sac
• Injury
• Immune system disease
• Reactions to certain drugs
• Radiation
• Metabolic causes, like kidney failure with uremia

What happens before the Pericardiocentesis procedure?

The patient should fast at least 6 hours before the procedure. Before the treatment, check with the doctor before you stop taking medications for other medical issues.

Before the procedure, the doctor may ask for additional tests. These may include the following:

• Chest X-ray
• An electrocardiogram (ECG) to assess the cardiac rhythm
• Blood tests determine a person’s overall health.
• An echocardiogram assesses blood flow through the heart and the fluid around it
• A CT scan or an MRI for additional information on the heart, if required
• Cardiac catheterization is a procedure that measures the pressure inside the heart

How is the Pericardiocentesis procedure carried out?

The patient should lie down on an exam table at a 60-degree angle. If the patient experiences a severe drop in blood pressure or a slowed heartbeat during surgery, the doctors may provide fluids or prescribe medications intravenously. A numbing agent is applied to the skin below and around the breastbone. During the procedure, the patient remains conscious.

The pericardial sac is ruptured using a needle and then guided in with the help of an echocardiogram. The patient may feel slight pressure during this procedure. It allows the doctor to see a moving image of the heart, aiding in fluid drainage monitoring. After needle insertion, the needle is replaced with a catheter. It takes 20 to 60 minutes to complete the entire procedure. 

The catheter remains in the patient’s chest for a few hours to allow fluid to drain into a container. Once the fluid is removed from the sac, the cardiologist removes the catheter. Pericardiocentesis is not the only method for removal of fluid around your heart. But, this method is preferred because it is less invasive than surgery. Sometimes doctors surgically drain the fluid in cases of chronic inflammation or fluid build-up, in those who may need part of the pericardium removed, or in individuals whose fluid has certain characteristics.

When should a patient seek medical help?

If a patient is experiencing symptoms of cardiac tamponade, infection, or sepsis, immediate medical attention is required.

The following are the symptoms of cardiac tamponade

• Chest pain
• Breathing difficulty
• Breathing unusually fast
• Spells of fainting and dizziness
• Lightheadedness
• Heart palpitation or rapid heartbeat

The following are the symptoms of infection and sepsis. Sepsis is a life-threatening condition.

• Redness or swelling near the needle entry point
• Fever or chills
• Confusion or disorientation
• Skin becomes warm to touch around the needle site

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What are the risks of Pericardiocentesis?

Every process entails some level of risk. Pericardiocentesis carries the following risks:

• Puncturing the heart, which may necessitate surgery
• Imjury to the liver
• Excessive bleeding strains the heart and hinders its ability to operate normally.
• There is air in the chest cavity
• Infection
• Abnormal heartbeats (which can cause death in rare instances)
• Fluid in the lungs due to heart failure (rare)

There’s also the possibility that the fluid around the heart may re-accumulate. If this happens, the patient may need to repeat the treatment or have the pericardium removed entirely or partially.

What does an abnormal Pericardiocentesis result mean?

The doctor may be able to pinpoint the cause of fluid accumulation. Discuss the results with the doctor to determine the significance and if the condition may recur. Doctors can guide the patients about the treatment options.

What to expect after the procedure?

After the procedure, the patient may resume normal activities. The doctor usually advises avoiding exercise for a while. Call the doctor if the patient develops a fever, has increased drainage or bleeding from the needle insertion site, chest pain, or any other serious symptoms. Follow the healthcare provider’s advice for medicines, exercise, food, and incision care. After pericardiocentesis, many people report that their symptoms have improved.

Conclusion

Pericardiocentesis is a life-saving procedure. The procedure relieves the heart from the pressure of the excess fluid around it and lets the heart pump normally.