Pericardiocentesis (Pericardial Tap, Cardiac Needle Aspiration)

Blood testsChest x-rays a test that uses radiation to take a picture of structures inside the body, especially bones Electrocardiogram (ECG, EKG) a test that records the hearts activity by measuring electrical currents through the heart muscle Echocardiogram a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart The day before and the day of your procedure: You will need to restrict your intake of fluid and food prior to your procedure. Your doctor or nurse will give you specific instructions.If you are diabetic, ask your doctor how to adjust your medications for the procedure.You may need to adjust other medications you are taking.Make sure you tell your physician all the medications (prescription and over-the-counter) that you are taking. AnesthesiaLight sedation to help you relax, but you will be awake and conscious during the procedure. Description of the ProcedureYou will lie on an operating table with your chest elevated at a 30-45 angle if possible. This is to bring the heart closer to the chest wall and to help with draining. An intravenous line will be inserted into your arm to administer a sedative that will help you relax. The area where the needle will be inserted will be washed with an antiseptic and if necessary, shaved. A local anesthesia will be injected at the insertion site to numb an area on your chest. Your heart will be monitored with an ECG.

Your doctor will insert the needle at a 45 angle into the chest and slowly move it towards the heart. He or she will use ultrasound or echocardiogram to help guide the needle to the correct location. Once at the pericardium, your doctor will advance the needle into the pericardial sac but no further (about 6-8 centimeters [cm] below the skin in adults and 5 cm or less in children).Once in the pericardial sac, your doctor will remove the fluid using the needle or insert a catheter to remove the fluid. After the needle or catheter is 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 to allow draining to continue over several hours or days. After ProcedureYou 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. How Long Will It Take?About 20-60 minutes Will It Hurt?You may feel pain when the needle penetrates the pericardium. Possible ComplicationsNeedle damage to an organ, such as lung, coronary vessel, myocardium, aorta, inferior vena cava, or esophagusVenous air embolism due to air entering the heart Infection ( pericarditis ) Disruption on the hearts normal rhythm (dysrhythmia) Average Hospital StayHospital stay can vary from one day to several days. Typically, you will stay overnight. If the catheter remains in place to continue draining fluid, you may stay in the hospital several days.

Postoperative Care When you return home, do the following to help ensure a smooth recovery: Clean the injection site daily with lukewarm water and sensitive soap like Cetaphil. Do not scrub the area.Avoid vigorous activities, especially those involving the upper body, until your physician says that you can resume them.Return to work and regular daily activities as soon as you are ready; sexual relations may resume as soon as you are able.Make and keep all postoperative appointments. Outcome The fluid removed from the pericardial sac is sent to a lab to be analyzed. Abnormal test results could be caused by many different things, including infection, cancer, rheumatoid arthritis , heart attack , or kidney failure . If you have abnormal test results, your physician will determine the treatment option that works best for your situation. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteChest pain or signs of a heart attackShortness of breath or difficulty breathingVomitingDizziness RESOURCES: American Heart Associationhttp://www.americanheart.org

National Heart, Lung, and Blood Institutehttp://www.nhlbi.nih.gov Women's Heart Foundationhttp://www.womensheartfoundation.org CANADIAN RESOURCES: Heart and Stroke Foundation of Canadahttp://ww2.heartandstroke.ca/ University Health Networkhttp://www.uhn.ca/ References: Ferri FF. Ferris Clinical Advisor: Instant Diagnosis and Treatment . 2006 ed. Philadelphia, PA: Mosby: Elsevier; 2006. Pericardiocentesis (pericardial tap). Cleveland Clinic Heart Center website. Available at: http://www.clevelandclinic.org/heartcenter/pub/guide/tests/procedures/pericardiocentesis.htm . Accessed September 16, 2005. Pericardium and pericarditis. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4683 . Accessed September 25, 2005. Protocol cardiac: pericardiocentesis. Vanderbilt University Medical Center Web site. Available at: http://www.mc.vanderbilt.edu/lifeflight/web/protocol/3i.htm . Accessed September 16, 2005. Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine . 4th ed. Philadelphia, PA: Saunders: Elsevier; 2004.

Spodick DH. Acute cardiac tamponade. New England Journal of Medicine . 2003;349:684-690. Tibbles CD, Porcaro W. Procedural applications of ultrasound. Emergency Medicine Clinics of North America. 2004;22:797-815. Last reviewed November 2007 by J. Peter Oettgen, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.