Pericardiocentesis – Pericardial Fluid Drainage
Pericardiocentesis is a medical procedure to remove excess fluid from the pericardial sac surrounding the heart. It is used to treat life-threatening cardiac tamponade.
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Pericardiocentesis is a medical procedure to remove excess fluid from the pericardial sac surrounding the heart. It is used to treat life-threatening cardiac tamponade.
What is Pericardiocentesis?
Pericardiocentesis, also known as a pericardial tap, is a medical procedure in which fluid is drained from the pericardium – the sac surrounding the heart. Under normal circumstances, the pericardial sac contains only a small amount of fluid that lubricates and cushions the heart. When excess fluid accumulates, this is called a pericardial effusion, which can severely impair the heart´s ability to pump blood and become life-threatening.
Indications – When is Pericardiocentesis Performed?
The procedure is indicated when a pericardial effusion compromises cardiac function or poses an immediate risk of doing so. Common indications include:
- Cardiac tamponade: A life-threatening emergency in which rising pressure in the pericardial sac prevents the heart from filling properly, potentially leading to cardiogenic shock.
- Large symptomatic pericardial effusion: Causing breathlessness, chest pain, or dizziness.
- Diagnostic pericardiocentesis: To analyze the fluid for infection, cancer cells, or other underlying causes.
- Recurrent pericardial effusion: When fluid re-accumulates despite medical treatment.
Causes of Pericardial Effusion
A pericardial effusion can result from a variety of conditions, including:
- Pericardial inflammation (pericarditis), often caused by viral infections
- Bacterial or tuberculous infections
- Malignant tumors (e.g., lung cancer, breast cancer, lymphomas)
- Autoimmune diseases (e.g., systemic lupus erythematosus)
- Heart attack complications (Dressler syndrome)
- Kidney failure (uremic pericardial effusion)
- Trauma or cardiac surgery
- Hypothyroidism (underactive thyroid)
How is the Procedure Performed?
Pericardiocentesis is performed under sterile conditions in a hospital setting, typically in an intensive care unit or cardiac catheterization laboratory. The procedure involves the following steps:
Preparation
Before the procedure, imaging studies such as echocardiography (cardiac ultrasound) and an electrocardiogram (ECG) are performed to locate the effusion and determine the optimal access route. The patient receives local anesthesia and is connected to continuous cardiac monitoring.
Needle Insertion
A long, thin hollow needle is inserted through the chest wall into the pericardial sac, usually under real-time ultrasound guidance. The most common approach is the subxiphoid route, entering just below the xiphoid process of the sternum. A guidewire is then passed through the needle (Seldinger technique), followed by the placement of a flexible drainage catheter.
Drainage
The accumulated fluid is slowly withdrawn and collected. In cases of large or recurrent effusions, a pericardial drain may be left in place for several hours or days to ensure complete drainage and prevent re-accumulation.
Risks and Complications
While pericardiocentesis is an invasive procedure, complication rates are low when performed by experienced specialists under imaging guidance. Potential risks include:
- Injury to the heart muscle or coronary arteries
- Pneumothorax (air entering the chest cavity)
- Post-procedural infection or pericarditis
- Cardiac arrhythmias during the procedure
- Bleeding or hematoma formation
- Accidental injury to adjacent organs such as the liver (rare)
Aftercare and Prognosis
Following the procedure, patients are closely monitored. Follow-up echocardiography is performed to confirm successful drainage and to detect any complications. Subsequent treatment depends on the underlying cause of the effusion – this may include anti-inflammatory therapy, antibiotics, or oncological treatment as appropriate.
References
- Adler, Y. et al. (2015): 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. European Heart Journal, 36(42), 2921-2964.
- Imazio, M. & Gaita, F. (2015): Pericardial diseases: a need for new guidelines. European Heart Journal, 36(42), 2873-2874.
- Maisch, B. et al. (2004): Guidelines on the diagnosis and management of pericardial diseases. European Heart Journal, 25(7), 587-610.
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