perikardiocentes

Perikardiocentesis is the medical procedure used to remove fluid from the pericardial cavity, typically to treat a pericardial effusion and relieve cardiac tamponade or to obtain diagnostic samples. It is usually performed with imaging guidance to improve safety and accuracy.

Indications include life-threatening cardiac tamponade, symptomatic or large pericardial effusions causing hemodynamic compromise, and diagnostic evaluation of effusions with unclear etiology (infection, malignancy, inflammatory or autoimmune disease).

Techniques commonly involve ultrasound guidance and access through the subxiphoid region, the left parasternal approach, or the apical region. The procedure is performed under local anesthesia, with or without light sedation. A needle or small-capacity catheter is inserted to drain fluid, and the aspirated fluid is sent for laboratory analysis (cytology, cultures, chemistry) as indicated. In some cases, a catheter may be left in place for continuous drainage.

Contraindications include uncorrected coagulopathy or severe thrombocytopenia, infection at the puncture site, or small, loculated effusions unlikely to yield benefit. Relative contraindications include significant anatomical distortion or patient instability, in which case alternative approaches or emergent surgical options may be considered.

Complications are uncommon but can include laceration of the myocardium or a coronary vessel, pneumothorax, arrhythmia, infection, or recurrence of the effusion. The risk is reduced by imaging guidance and experienced operators.

Outcomes depend on the underlying cause and the rapid relief of tamponade when present. Perikardiocentesis provides immediate hemodynamic improvement in tamponade and offers diagnostic information to guide further treatment, which may include medical therapy or surgical pericardial window or drainage if fluid recurs.