pericardiocentesis

Pericardiocentesis is a medical procedure that extracts fluid from the pericardial space surrounding the heart. It is performed to relieve pressure from a pericardial effusion, which can impair cardiac filling, or to obtain pericardial fluid for diagnostic testing. The procedure can be performed percutaneously or surgically, with percutaneous techniques often guided by imaging.

Indications include suspected cardiac tamponade or hemodynamic compromise due to a sizable pericardial effusion, relief of symptoms in patients with large effusions, and diagnostic sampling when the cause of the effusion is unclear (such as infection, malignancy, or autoimmune disease). It may be indicated after cardiac surgery when fluid collection progresses or recurs. Contraindications include small, asymptomatic effusions where drainage is not needed, uncorrected coagulopathy or bleeding disorders, and situations where there is no accessible pericardial space or high risk of complications. In such cases alternative treatments, including surgical pericardial window or pericardiectomy, may be considered.

Procedure overview includes establishing informed consent and imaging guidance, typically echocardiography, to identify the fluid and guide needle placement. The most common percutaneous approaches are subxiphoid and apical, with parasternal and other routes used in specific situations. After sterilization and local anesthesia, a needle is advanced into the pericardial space with continuous aspiration. If fluid is obtained, it may be drained or a catheter may be placed for ongoing drainage. Post-procedure imaging ensures proper catheter position and assesses for recurrence; hemodynamic status is monitored.

Complications can include injury to the heart or coronary vessels, pneumothorax, arrhythmias, infection, bleeding, or re-accumulation of fluid. When effective, it can provide rapid relief of tamponade symptoms and yield diagnostic information.