What is pericardiocentesis?

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, the 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.

Which conditions is pericardiocentesis done ?

Infection of the heart or pericardial sac (tuberculosis)

Cancer

Inflammation of the pericardial sac due to a heart attack

Injury

Immune system disease

Reactions to certain drugs

Radiation

Metabolic causes, like kidney failure with uremia

Sometimes the cause of fluid buildup is unknown.

What are the risks of pericardiocentesis?

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

Infection

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.

What happens during pericardiocentesis?

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.

What happens after pericardiocentesis?

In general, after your pericardiocentesis:

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

Many people note improvements in their symptoms right after having pericardiocentesis