(Pericardial Tap; Cardiac Needle Aspiration)
Definition
Definition
The pericardial sac surrounds the heart. It normally contains a small amount of fluid. Pericardiocentesis is the withdrawal of fluid from this sac with a needle.
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Reasons for Procedure
Reasons for Procedure
Pericardiocentesis may be used as a treatment. If too much fluid builds up in the sac, this can put extra pressure on the heart. This is known as cardiac tamponade. It is a life-threatening condition. Withdrawing some of the fluid will help to relieve the pressure on the heart.
Pericardiocentesis may also be used to diagnose the cause of fluid buildup. Fluid buildup is known as pericardial effusion. The buildup can be caused by an infection, cancer, trauma, autoimmune disorders, or drug use. It may also indicate the presence of rheumatoid arthritis, heart attack, or kidney failure.
Possible Complications
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Needle damage to an organ in the chest, like the lung or heart
- Bleeding
- Infection
- Disruption of the heart’s normal rhythm
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
What to Expect
What to Expect
Prior to Procedure
Pericardiocentesis may be a scheduled or emergency procedure. This can have an impact on which tests are done prior to the procedure. The following tests may be conducted prior to your procedure:
- Blood tests
- Chest x-rays
- Electrocardiogram (EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
- Echocardiogram —an ultrasound test to assess the heart
Leading up to your procedure:
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
- You will need to restrict your intake of fluid and food prior to the procedure. The doctor or nurse will give you specific instructions.
- If you have diabetes, ask your doctor how to adjust your medications for the procedure.
Anesthesia
Light sedation will be given to help you relax. You will be awake during the procedure. A local anesthesia will be injected at the insertion site. It will numb an area on your chest.
Description of Procedure
Your heart will be monitored. The needle will be inserted into the chest. It will be slowly moved toward the heart. Ultrasound and possibly fluoroscopy will be used to help guide the needle to the correct location. The needle will be passed into the pericardial sac, but no further.
Once in the pericardial sac, the fluid will be removed. The needle may be used, or a catheter tube may be inserted over the needle. After some fluid is collected or enough of the fluid has drained out, the needle or catheter will be removed. Pressure will be applied to the injection site for several minutes. This is done to stop the bleeding.
In some cases, your doctor may leave the catheter in place. This will allow draining to continue over several hours or days.
Immediately After Procedure
You will have a chest x-ray to make sure your lung has not been punctured. You will be closely monitored for several hours after the procedure. Your pulse, blood pressure, and breathing will be checked regularly.
The fluid removed from the pericardial sac is sent to a lab to be analyzed.
How Long Will It Take?
About 20-60 minutes
How Much Will It Hurt?
You may feel pain when the needle is inserted.
Average Hospital Stay
Hospital stay can vary from one day to several days. If the catheter remains in place to continue draining fluid, you may need to stay in the hospital several days.
Postoperative Care
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incisions
Call Your Doctor
Call Your Doctor
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the insertion site
- Pain that you cannot control with the medicines you have been given
- Cough, difficulty breathing, or chest pain
- Nausea or vomiting
- Lightheadedness
If you think you have an emergency, call for medical help right away.
RESOURCES:
National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov
CANADIAN RESOURCES:
Heart and Stroke Foundation of Canada http://www.heartandstroke.com/
References:
Pericardial effusion. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated October 15, 2010. Accessed January 23, 2013.
Pericardiocentesis. Cleveland Clinic website. Available at:
http://my.clevelandclinic.org/services/services/pericardiocentisis
Accessed December 30, 2014.
Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349(7):684-690.
Tibbles CD, Porcaro W. Procedural applications of ultrasound. Emerg Med Clin North Am. 2004;22(3):797-815.
What is pericarditis. American Heart Association website. Available at:
http://www.heart.org/HEARTORG/Conditions/More/What-is-Pericarditis_UCM_444931_Article.jsp
Updated July 29, 2014. Accessed December 30, 2014.
6/3/2011 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last Updated: 12/20/2014