Pericardiocentesis is a procedure done to remove fluid that has built up in the sac around the heart (pericardium). It's done using a needle and small catheter to drain excess fluid.
A fibrous sac known as the pericardium surrounds the heart. This sac is made of two thin layers with a small amount of fluid between them. This fluid reduces friction between the layers as they rub against each other when the heart beats. In some cases, too much fluid builds up between these two layers. This is called pericardial effusion. When this happens, it can affect the normal function of the heart. Pericardiocentesis drains this fluid and prevents future fluid buildup.
During pericardiocentesis, a doctor inserts a needle through the chest wall and into the tissue around the heart. Once the needle is inside the pericardium, the doctor inserts a long, thin tube called a catheter. The doctor uses the catheter to drain excess fluid. The catheter may come right out after the procedure. Or it may stay in place for several hours or overnight. This is to make sure all the fluid has drained, and to prevent fluid from building up again.
Many medical conditions can cause fluid to build up around the heart. This fluid buildup can cause shortness of breath and chest pain. This may be treatable with medicine. In other cases, this fluid buildup is life threatening and needs draining right away.
Pericardiocentesis can help drain the fluid around the heart. And it can help diagnose the cause of the extra fluid. Conditions that can cause pericardial effusion include:
- Infection of the heart or pericardial sac
- Inflammation of the pericardial sac due to a heart attack
- Immune system disease
- Reactions to certain drugs
- Metabolic causes, like kidney failure with uremia
Sometimes the cause of fluid buildup is unknown.
Pericardiocentesis is not the only method to remove fluid around the heart. However, it is preferred because it is less invasive than surgery. Sometimes doctors surgically drain the fluid. This may be done in people who have had chronic fluid buildup or inflammation, in people who might need part of the pericardium removed, or in people whose fluid has certain characteristics.
All procedures have some risks. The risks of pericardiocentesis include:
- Puncturing the heart, which may require surgery to repair
- Puncturing the liver
- Excess bleeding, which might compress the heart and affect its normal function
- Air in the chest cavity
- Abnormal heart rhythms (which can cause death in rare instances)
- Heart failure with fluid in the lungs (rare)
There is also a chance that the fluid around the heart will come back. If this happens, you might need to repeat the procedure, or you might eventually need all or part of your pericardium removed.
Your own risks may vary according to your age, your general health, and the reason for your procedure or type of surgery you have. They may also vary depending on the anatomy of the heart, fluid, and pericardium. Talk with your healthcare provider to find out what risks may apply to you.
Ask your doctor how to prepare for pericardiocentesis. You will probably need to avoid eating and drinking for 6 hours or more before the procedure. Ask the doctor whether you need to stop taking any medicines before the procedure.
The doctor may want some extra tests before the surgery. These might include:
- Chest X-ray
- Electrocardiogram (ECG), to check the heart rhythm
- Blood tests, to assess general health
- Echocardiogram, to view blood flow through the heart and the fluid around the heart
- CT or MRI, if the doctor needs more information about the heart
- Heart catheterization, to measure the pressure within the heart
Talk to your doctor about what will happen during your procedure. A cardiologist and a surgical team will do the procedure. The following is a description of catheter-based pericardiocentesis, the most common form. In general:
- You will be awake. An IV will be inserted in your hand or arm. You will most likely be given medicine to make you sleepy before the procedure starts.
- Your vital signs will be closely watched.
- The procedure should take around an hour.
- Your doctor will do an echocardiogram to view the fluid around your heart and your heart anatomy. This will help determine the best place to insert the needle.
- The doctor will apply a local anesthetic at the needle insertion site, below the breastbone.
- The doctor will insert the needle through the skin. You might feel this as pressure or slight pain. You can have pain medicine if needed.
- The needle will be guided to the fluid in the pericardial sac with the help of an echocardiogram or X-ray imaging (fluoroscopy).
- Once the needle is in the correct area, it will be removed and replaced with a catheter. Fluid will drain out through the catheter. In some cases, this catheter may stay in place for several hours or even days. In other cases, it may come out sooner.
- The catheter will be removed when enough fluid has drained. Pressure will be applied to the catheter insertion site to prevent bleeding.
Ask your doctor about what to expect after the procedure. In general, after your pericardiocentesis:
- You may be groggy and disoriented upon waking.
- Your vital signs, such as your heart rate, breathing, blood pressure, and oxygen levels, will be carefully watched.
- If the catheter that was used to drain the fluid is left in place, it will be checked to make sure it's not blocked before it can be safely removed.
- You may have an echocardiogram to confirm the absence of fluid re-accumulation.
- You may have a chest X-ray to make sure the needle did not puncture your lung during the procedure.
- A sample of the drained fluid may be sent to a lab for testing.
- You will probably need to stay in the hospital for one or more days. This may partly depend on the reason for your pericardiocentesis.
After you leave the hospital:
- You should be able to resume normal activities relatively soon, but avoid vigorous exercise until your doctor says it's OK.
- Make sure you keep all of your follow-up appointments.
- Call the doctor if you have fever, increased draining from the needle insertion site, chest pain, or any severe symptoms.
- Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.
Many people note improvements in their symptoms right after having pericardiocentesis.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
European Heart Journal (2015), ESC Guidelines for the diagnosis and management of pericardial diseases, http://eurheartj.oxfordjournals.org/content/ehj/36/42/2921.full.pdf, Emergency Pericardiocentesis, Up To Date, Diagnosis and treatment of pericardial effusion, Up To Date, Silvestry, FE., Echocardiography Guided Interventions, American Society of Echocardiography; 215-217, Haddad, DE., Outcomes of Cancer Patients Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion, Journal of the American College of Cardiology (2015); 66(10); 1119-1128, Kern, M., When do you need to do pericardiocentesis? Cath Lab Digest (2014); 22(9)
Sudheendra, Deepak, MD,Cunningham, Louise, RN