Perikardiocentesis

Pericardiocentesis is a procedure to aspirate fluid from the pericardial sac surrounding the heart. It is performed to diagnose and treat pericardial effusion and can be life-saving in cardiac tamponade, where fluid accumulation impairs the heart’s ability to fill. The procedure provides rapid hemodynamic relief and yields fluid for laboratory analysis to determine etiology.

Indications include cardiac tamponade, large or symptomatic pericardial effusions, suspected purulent or malignant effusions, and diagnostic sampling when noninvasive tests are inconclusive. It may be used as a bridge to definitive therapy or surgery or to relieve symptoms while planning longer-term management.

Technique commonly involves imaging guidance, most often transthoracic echocardiography. Approaches include subxiphoid or apical access. The procedure is performed under sterile conditions with local anesthesia; a needle or small catheter is advanced into the pericardial space to withdraw fluid. If needed, a drain or catheter may be left in place for ongoing drainage. Fluid samples are sent for cytology, culture, and biochemical analysis. Imaging guidance reduces the risk of complications and increases success rates.

Complications can include injury to the heart or coronary vessels, pneumothorax, hemothorax, arrhythmias, infection, or re-accumulation of fluid. Bleeding risk is elevated in patients with coagulopathy or on anticoagulation; coagulopathy should be corrected when possible prior to the procedure.

Aftercare involves monitoring, repeat imaging to assess residual effusion, drain management if a catheter was placed, and treatment of the underlying cause. In cases of recurrent effusions, alternatives such as pericardial window or pericardiectomy may be considered.