Pericardial tap; Percutaneous pericardiocentesis
Pericardiocentesis involves the use of a needle to withdraw fluid from the pericardial sac (membrane that surrounds the heart). The procedure may be used to remove fluid that is compressing the heart, or the fluid may be evaluated for diagnostic purposes.
How the test is performed
In the past this procedure was performed in a Cardiac catheterization laboratory, but now it is usually performed in the procedure room of an intensive care unit, or even at the bedside.
An IV line is inserted, to be used if 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 and guided 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 needle reached the pericardial sac, a guide wire is passed. The needle is removed and and replaced with a catheter. The fluid is withdrawn through this catheter and put into containers. Usually this pericardial catheter is left in place for continuous draining for several hours.
Surgical pericardiocentesis may be necessary in difficult cases. In this procedure the fluid is drained through a more invasive procedure that may require additional anesthesia.
How to prepare for the test
If the test is elective, you will be asked 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:
- Infant test or procedure preparation (birth to 1 year)
- Toddler test or procedure preparation (1 to 3 years)
- Preschooler test or procedure preparation (3 to 6 years)
- School age test or procedure preparation (6 to 12 years)
- Adolescent test or procedure preparation (12 to 18 years)
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).
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 the following:
- Congestive heart failure
- Cardiac trauma
- Rupture of a ventricular aneurysm (stretching and bulging of a weakened ventricular wall)
What the risks are
- Puncture of 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 ( Heart attack )
- Needle-induced arrhythmias (irregular heartbeats)
- Infection (pericarditis)
- Puncture of the lung, liver, or stomach
by David A. Scott, M.D.