What Is Pericardiocentesis?
Pericardiocentesis is a procedure used to remove excess fluid from around the heart. It is commonly performed as a treatment for a life-threatening condition that can potentially cause cardiac arrest. A needle is inserted into the chest until its tip reaches the pericardium, the sac surrounding the heart. Once positioned, healthcare providers can use the needle to directly drain fluid or place a drain for gradual fluid removal over time.
A pericardiocentesis procedure treats pericardial effusion, accumulating excessive fluid in the pericardium. (A small amount of fluid in the pericardium is average.) The pericardium holds the heart in place and protects it from external movement. Pericardial effusions can cause cardiac tamponade, a medical emergency that can result in cardiac arrest, which can be fatal within minutes to hours.
Pericardiocentesis can be used as either an emergency or non-emergency treatment. In emergencies, it treats cardiac tamponade or severe pericardial effusions that may lead to cardiac tamponade. In non-emergency cases, healthcare providers often use pericardiocentesis as a diagnostic procedure to identify the underlying cause of fluid accumulation around the heart.
When Is Pericardiocentesis Performed?
Several medical diseases and conditions can cause abnormal fluid around the heart’s sac, leading to shortness of breath and generalized discomfort. In some cases, fluid accumulation can be treated with medicine. On the other hand, this fluid also has the potential to turn into a life-threatening build-up and 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?
Complications from pericardiocentesis occur in approximately 5% to 40% of cases. The risk of complications is minimized when imaging techniques such as echocardiography or fluoroscopy assist the provider in accurately guiding the needle. In extreme emergencies, it is possible to perform this procedure without imaging guidance. However, this approach is rare and should only be considered when no other options are available. Even with imaging guidance, pericardiocentesis involves inserting a needle near several vital organs and major blood vessels.
This poses a risk of injuring any of the following:
- Heart: This can lead to a heart attack, bleeding, or disruption of the heart's electrical system, resulting in an irregular heart rhythm (arrhythmia). These complications can be severe or even life-threatening, requiring emergency heart surgery for repair.
- Lungs: Injuries or punctures can cause a collapsed lung, which is a potentially life-threatening condition.
- Diaphragm.
- Major blood vessels near the heart.
- Pericardium: Damage to the pericardium can result in fluid leakage into the chest or the accumulation of air within the pericardium.
- Stomach.
- Liver.
Any medical procedure that involves piercing the skin carries the risk of infection. If these infections spread, they can trigger an overwhelming immune response known as sepsis, a life-threatening medical emergency.
What Happens During Pericardiocentesis?
Pericardiocentesis is a multidisciplinary procedure involving a cardiologist and a surgical team. Catheter-based pericardiocentesis is one of the most common forms.
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 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 determine 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 removed after a good amount of fluid has been drained.
- Pressure is applied at the catheter insertion site to prevent profuse bleeding.
What Happens After Pericardiocentesis?
Pericardiocentesis is generally completed within 60 minutes. However, if the fluid drains out quickly, the procedure may be over within 20 minutes.
- The patient may be confused and disoriented after gaining consciousness.
- Vital signs are monitored.
- The catheter is left in place and 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.
When Is It Necessary for a Person to Go to the Hospital?
Individuals should seek medical attention if they experience any of the following symptoms after undergoing this procedure:
Symptoms of Cardiac Tamponade:
- Chest pain.
- Difficulty breathing or rapid breathing.
- Dizziness, fainting, or lightheadedness.
- Heart palpitations or rapid heartbeat.
Symptoms of Infection and Sepsis:
Immediate medical attention is necessary if the person experiences any symptoms of infection. These symptoms could indicate sepsis, a life-threatening condition that is as serious as a heart attack or stroke.
The symptoms of sepsis include:
- Swelling or redness around the site where the needle was inserted.
- Skin that feels unusually warm to the touch around the insertion site.
- Fever or chills.
- Confusion or disorientation, wildly if the person is not behaving as usual.
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 be noticed. 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, punctually taking the prescribed medication, and wound care are crucial. This will help heal the insertion site and avoid the recurrence of fluid build-up within the heart. Living a healthy lifestyle that includes a balanced diet and regular fitness activities will eventually keep any form of cardiovascular condition at bay.
