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Pericardiocentesis

Last updated April 19, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Npatchett

Pericardiocentesis is a procedure that involves removing excess fluid from within the pericardial sac (around the heart) using needle aspiration.


Background Information:

What are the other Names for the Procedure?

  • Percutaneous Pericardiocentesis
  • Pericardial Tap

What is the Pericardiocentesis surgical procedure?

Pericardiocentesis is a procedure that involves removing excess fluid from within the pericardial sac (around the heart) using needle aspiration.

What part of the Body does the Procedure involve?

The Pericardiocentesis procedure involves the pericardium and the blood vessels roots, such as the aorta, pulmonary artery, pulmonary vein, and vena cava.

Why is the Pericardiocentesis surgical procedure Performed?

The Pericardiocentesis procedure is performed to remove excess fluid accumulation between the heart and the pericardium.

What are some Alternative Choices for the Procedure?

There are no alternatives to a Pericardiocentesis procedure when indicated.

What are the Recent Advances in the Procedure?

There are no recent advancements to the Pericardiocentesis procedure.

What is the Cost of performing the Pericardiocentesis surgical procedure?

The cost of a Pericardiocentesis procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding an Pericardiocentesis procedure and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Pericardiocentesis surgical procedure:

How is the  Pericardiocentesis surgical procedure Performed?

  • The Pericardiocentesis procedure may be performed under local anesthesia with the patient seated in an inclined position with his/her head elevated by 30-40 degrees
  • After numbing the puncture site, a needle is inserted under the tip of the chest bone and into the pericardium (the sac surrounding the heart) using image guidance
  • A sample of the pericardial fluid withdrawn may be sent in for analysis, if the procedure is performed for diagnostic purposes or just drained, if it is done to relieve pressure on the heart due to fluid accumulation
  • After the needle is withdrawn, firm pressure is applied to minimize any bleeding

Where is the Procedure Performed?

A Pericardiocentesis procedure is usually performed in an out-patient surgery center facility or a hospital.

Who Performs the Procedure?

A cardiovascular surgeon and occasionally a cardiologist perform the Pericardiocentesis procedure.

How long will the Procedure take?

The entire procedure takes a about few minutes, but there may be wait times and preparation times involved.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Pericardiocentesis procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Pericardiocentesis procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Pericardiocentesis surgical procedure?

Before Pericardiocentesis, the patient has to undergo certain tests such as:

  • Chest X-ray
  • Computerized tomography (CT) scan of the chest
  • Electrocardiogram (ECG)

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Pericardiocentesis procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
  • What are the costs involved?

During the Pericardiocentesis surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia is administered for the Pericardiocentesis procedure.

How much Blood will you lose, during the Procedure?

An uncomplicated Pericardiocentesis procedure does not involve a significant blood loss.

What are the possible Risks and Complications during the Pericardiocentesis surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
  • Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders and chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Pericardiocentesis surgery are:

  • Excessive bleeding
  • Infection
  • In rare cases, accidental puncture to an organ or artery

What Post-Operative Care is needed at the Healthcare Facility after the Pericardiocentesis surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Pericardiocentesis surgical procedure:

What are the possible Risks and Complications after the Pericardiocentesis surgical procedure?

The possible risks and complications that may arise after the Pericardiocentesis procedure are:

  • Excessive bleeding from the surgical wound
  • Irregular heartbeat
  • Hemothorax (blood collection in the pleural cavity)
  • Pneumothorax (fluid collection between the lung and chest wall resulting in a lung collapse)

What is the Prognosis after the Surgery?

Generally, the complication rate after a Pericardiocentesis procedure is very low.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Feeling of anxiety
  • Difficulty breathing
  • Signs of an infection
  • Headache, muscle aches
  • Fever, feeling sick
  • Dizziness
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Pericardiocentesis surgical procedure?

At home, the following post-operative care is recommended, after a Pericardiocentesis procedure:

  • Avoid smoking
  • Complete the course of prescribed medication
  • Take antibiotic medication to help combat or prevent infection, per your physician’s advice
  • Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)
  • Avoid all activities that are physically strenuous, until there is a complete healing of the surgical wound (under advice of your physician)
  • Individuals may be advised to add a healthy amount of vitamin and mineral supplements to their daily diet for a few days or weeks

How long does it normally take to fully recover, from the Procedure?

Normally, the Pericardiocentesis procedure is only a minor surgical procedure. A recovery from the procedure should take about a few days.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Pericardiocentesis surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility, physician’s office, or a hospital
  • An anesthesiologist (if anesthesia was administered)
  • A cardiovascular surgeon or occasionally a cardiologist
  • A pathologist

The patient is advised to inquire and confirm the type of billing, before the Pericardiocentesis procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 21, 2015
Last updated: April 19, 2018