Pericardiocentesis. It consists of the extraction of fluid from the pericardial sac through a catheter, that is, puncture of the pericardial space to drain the fluid, for therapeutic purposes, generally for the evacuation of a pericardial effusion or cardiac tamponade , or for diagnostic purposes .
Summary
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- 1 Indications
- 2 Technique and way in which the exam is carried out
- 3 Route to follow during the procedure
- 4 Preparation for the exam
- 5 How the test will feel
- 6 Reasons why the exam is performed
- 7 Normal Values
- 8 Meaning of abnormal results
- 9 Possible complications
- 10 risk factors
- 11 Alternative names
- 12 Sources
Indications
It is used in wounds of heart tamponade and cardiac arrest or impending failure, purulent pericarditis and chronic pericarditis (uremic, tuberculosis etc.), procedure as diagnostics and as a treatment modality.
Technique and way in which the exam is carried out
Diagram applying local anesthesia in an area under the sternum .
The procedure is usually carried out in the intensive care unit’s procedure room or even at the patient’s bedside.
The doctor will place an intravenous line in the person’s arm , in case it is necessary to administer liquids or medications through a vein . For example, a medicine can be given if the person has a slow heartbeat or a drop in blood pressure during the procedure.
It will clean an area just below the breastbone and apply local anesthesia . Then, you will insert a needle and guide it into the pericardial sac. The Echocardiography is used to help position the needle and monitor drainage of liquid , although derivations of the electrocardiogram (ECG) may also be employed to assist with positioning. It is sufficient needle of lumbar puncture No.18 or 20 and syringe 20 to 50 cc.
Route to follow during the procedure
The most recommended route is the subxiphoid. After asepsis with iodized alcohol or iodopovidone and anesthetized locally with lidocaine (in urgent cases local anesthesia is omitted), the needle is inserted through the left side of the xiphoid at a 45 ° angle , in the substernal direction and directed towards the left shoulder . Continuous suction is made as it is inserted, stopping when fluid is obtained or the heartbeats transmitted to the needle are felt. In the latter case, the myocardium has been located, so the needle should be withdrawn slightly to avoid injury.
Another route that can be used is through the 4th or 5th left intercostal spaces, 2 cm outside the sternal border on that side to avoid the internal mammary vessels. Proceed as in a thoracentesis , sucking as it is penetrated and stopping at the time of obtaining liquid . Under elective conditions, EKG monitoring can be used to avoid injury to the myocardium . The precordial lead electrode is placed aseptically on the puncture needle , observing the electrocardiographic tracing as the needle advances. When the myocardium is touched ST segment elevation, extrasystoles or negative QRS deflection are observed.
In cases of chronic pericarditis and purulent pericarditis, the obtained liquid should be sent for Gram staining, culture, cytochemical study and cytological study. When there is a recurrence, such as in chronic pericarditis, or when there is very thick pus that does not come out of the needle or when the effusion is loculated, a pericardial window should be made subxiphoidly in order to have an open drain .
Once the needle has reached the correct area , it is removed and replaced with a tube called a catheter, through which the fluid drains into containers. Generally, the catheter is left in place, so that the drain continues for several hours. In some difficult cases, surgical pericardiocentesis may be necessary. In this procedure, the fluid is drained through a more invasive method that may require anesthesia .
Preparation for the exam
The patient cannot eat or drink anything for six hours before the exam. In addition, you must sign an authorization.
How the test will feel
Pressure can be felt as the needle enters. Some people experience chest pain that may require the use of pain relievers .
Reasons why the test is performed
This test can be done to remove and examine the fluid that is putting pressure on the heart. It is usually done to assess the cause of a recurrent or chronic pericardial effusion. It can also be done to treat cardiac tamponade.
Normal values
There is usually a small amount of clear, yellowish-white fluid in the pericardial space.
Meaning of abnormal results
Abnormal findings may indicate the causes of the accumulation of pericardial fluid, such as:
- Cancer
- Cardiac perforation
- Cardiac trauma
- Congestive heart failure
- Pericarditis
- Rupture of a ventricular aneurysm
Possible complications
If the needle is not oriented in the substernal direction but is directed more posteriorly, the left atrium, whose wall is thin and bleeds easily , can be injured . Other complications include laceration of the coronary or mammary vessels, contamination of the pleural cavity in cases of purulent pericarditis , pneumothorax, and, rarely, hepatic laceration when the subxiphoid route is chosen.
Risk factor’s
- Hemorrhage
- Pulmonary atelectasis
- Heart attack
- Infection ( pericarditis )
- Irregular heartbeat ( cardiac arrhythmia )
- Puncture of the heart muscle , coronary arteries , lung , liver, or stomach .
- Pneumopericardium (air in the pericardial sac)
Alternative names
- Pericardial puncture.
- Percutaneous pericardiocentesis
