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Heart, front view
Heart, front view
Pericardium
Pericardium

Pericardiocentesis
Definition:
The pericardiocentesis uses a needle to withdraw fluid from the pericardial sac (membrane that surrounds the heart) to evaluate the fluid for diagnostic purposes, or to remove fluid causing compression of the heart.

Alternative Names:
Pericardial tap; Percutaneous pericardiocentesis

How the test is performed:

This procedure has historically been performed in the catheterization laboratory, but is now usually performed in the procedure room of an intensive care unit, or even at the bedside.

An IV line is inserted in case fluids or medications need to be given. Medication may be given to prevent vasovagal reflex resulting in bradycardia (a slowing of the heartbeat) and hypotension (fall in blood pressure). The insertion site just below the sternum (breastbone) will be cleansed and a local anesthetic will be given.

A pericardiocentesis needle will then be introduced into the pericardial sac. Electrocardiographic (ECG) leads may be attached by a clip to the needle to help with proper needle positioning. An echocardiogram is more frequently used to help in positioning the needle and monitoring the drainage procedure.

Once the pericardial sac is reached, a guide wire is passed, the needle removed, and a catheter replaces it. The fluid is withdrawn through this catheter and put into containers.  Usually the indwelling pericardial catheter is left in place for continuous draining for several hours.

Surgical pericardiocentesis (i.e., drainage of the pericardium through a more invasive procedure, requiring local anesthesia) may be necessary in difficult cases.
How to prepare for the test:

Adults:
If the test is elective, you will need to restrict fluid and food for 6 hours before the test. You must sign a consent form.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:
How the test will feel:
There may be a feeling of pressure as the needle enters. Some individuals feel transient chest pain, which may require pain medication.
Why the test is performed:
This test is usually done to evaluate the cause of a chronic or recurrent pericardial effusion (fluid in the pericardial sac). It may also be done as a treatment measure to relieve cardiac tamponade (compression of the heart from an accumulation of fluid within the pericardial sac).
Normal Values:
There is normally a small amount of clear, straw-colored fluid in the pericardial space.
What abnormal results mean:

Abnormal findings may indicate the cause of pericardial fluid accumulation such as:

What the risks are:
  • puncturing the myocardium (heart muscle) or a coronary artery (vessels that supply blood to the heart muscle)
  • pneumopericardium (allowing air into the pericardial sac)
  • myocardial infarction
  • needle-induced arrhythmias (irregular heartbeats)
  • infection (pericarditis)
  • puncture of the lung, liver, or stomach
Special considerations:
Not applicable.
Review Date: 2/26/2001
Reviewed By: Elena Sgarbossa, M.D. Cardiology Department, Rush-Presbyterian St. Luke’s Medical Ctr., Chicago, IL. Review provided by VeriMed Healthcare Network.
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