Pericardiocentesis - Indications, Risks, and Procedure

Introduction

The heart is surrounded by a fibrous sac known as the pericardium. This fibrous sac is composed of two fine layers with a minimal quantity of fluid in between them. This fluid avoids the friction produced between the two delicate layers because they generally rub against each other while the heart is beating. However, fluid builds up in excess amounts between the two layers in a few cases. This condition is referred to as pericardial effusion. The presence of pericardial effusion can negatively affect the regular function of the heart.

Pericardiocentesis is the procedure of draining this fluid and preventing future fluid build-up. Pericardiocentesis is also called a pericardial tap in which a catheter and needle are used to remove the liquid from the pericardium. The drained fluid is then tested for the presence of infection markers, inflammation, and the presence of blood and cancer cells. Rarely pericardiocentesis is performed in an emergency to treat a cardiac tamponade, a life-threatening rapid fluid accumulation around the. Pericardiocentesis is conducted to determine if the fluid is infectious or cancerous in nature. It also relieves the patient of pain and other symptoms such as shortness of breath. Along with the fluid drainage, the inserted catheter is also removed. The procedure is done within an hour. At times, the catheter is left for up to 48 hours in order to drain any excess fluid.

When Is Pericardiocentesis Performed?

Several medical diseases and conditions can cause abnormal fluid to build up around the heart’s sac, leading to shortness of breath and generalized discomfort. In some cases, fluid accumulation can be treatable by medicine. But on the other hand, this fluid also holds the potential to turn into a life-threatening build-up hence needs to be drained right away. Pericardiocentesis can additionally diagnose the cause of the fluid accumulation. It should be noted that the cause of fluid accumulation remains unknown, rarely even post pericardiocentesis.

Some conditions that require pericardiocentesis as a treatment modality or even as a diagnostic tool are mentioned below.

• Infection of the heart.

• Infection of the pericardial sac.

• Cancer.

• Inflammation of the pericardial sac.

• Heart attack.

• Cardiovascular injury.

• Immune system disorders.

• Reactions to specific drugs.

• Radiation therapy.

• Metabolic imbalance.

• Kidney failure.

• Uremia.

• Chronic pericardial effusion.

• Cardiac tamponade.

What Are the Risks of Pericardiocentesis?

Pericardiocentesis is not the sole method of removing excess fluid in the heart. However, it is widely preferred because of being less invasive than other surgical procedures. Healthcare professionals may sometimes surgically drain the fluid in individuals with chronic fluid accumulation or constant inflammation. Such individuals may require partial removal of the pericardium. Every procedure involves some amount of risk. Such risks are dependent on various factors such as age and the presence of any underlying health condition. The anatomy of the pericardium, along with the heart, is a critical factor in developing risks as well.

Mentioned below are some of the known dangers of pericardiocentesis.

• Puncturing of the heart leads to surgical repair for correction.

• Puncturing the liver.

• Excess bleeding.

• Compression of the heart.

• Abnormality in the regular functioning of the heart.

• Air is getting filled in the chest cavity.

• Infection.

• Abnormal heart rhythms.

• Heart failure.

• Fluid accumulation in the lungs.

• Return of fluid build-up.

What Happens During Pericardiocentesis?

Pericardiocentesis is a multidisciplinary procedure generally involving a cardiologist and a surgical team. Catheter-based pericardiocentesis is one of the most common forms of pericardiocentesis.

Mentioned below are the steps that occur during pericardiocentesis. However, they may alter according to the type of surgery and other healthcare provider-related factors.

• Anesthesia is administered through the intravenous route in order to make the individual fall asleep.

• The patient’s vital signs are closely watched.

• An echocardiogram is done to visualize the fluid and the heart’s anatomy, which helps in determining an accurate place for needle insertion.

• The needle is generally inserted below the breastbone.

• The needle is then guided to the fluid of the pericardial sac due to an echocardiogram.

• X-ray imaging or fluoroscopy can be done in place of an echocardiogram.

• The needle is removed and then replaced with a catheter.

• The fluid then begins to drain out via the catheter.

• The catheter is then removed after a good amount of fluid has been drained.

• Pressure is applied at the catheter insertion site in order to prevent profuse bleeding.

What Happens After Pericardiocentesis?

Pericardiocentesis is generally completed within 60 minutes. However, in case the fluid drains out quickly, the procedure may even get over within 20 minutes.

• The patient may be confused and disoriented after gaining consciousness.

• Vital signs are monitored.

• In case the catheter is left in place, it is checked for any blockage.

• An echocardiogram is done to confirm the absence of fluid.

• A chest x-ray is done to make sure there is no puncture in the heart or nearby structures.

• The drained fluid is then sent to a lab for testing.

Conclusion

Pericardiocentesis is a noninvasive procedure to remove the excess fluid accumulated in the pericardium; once the process is complete, the patient may resume normal activities within a week. Vigorous exercise should be avoided. Regular follow-up appointments post-procedure should not be missed. The healthcare provider must be informed of fever or chest pain symptoms. There are some risks associated with pericardiocentesis, but if the procedure is handled with expertise, there are fewer chances of any kind of risk. Following the instructions post pericardiocentesis and punctually taking the prescribed medication along with wound care is crucial. This will help in healing the insertion site and avoid the recurrence of fluid build-up within the heart. Living a healthy lifestyle that includes a balanced diet as well as regular fitness activities will eventually keep at bay any form of cardiovascular condition.