Pericardiocentesis

Excerpt

Pericardiocentesis is a procedure performed to remove pericardial fluid from the pericardial sac. It is often performed in the setting of cardiac tamponade to correct hypotension due to decreased stroke volume from extrinsic compression of the heart chambers. It can also be performed in elective settings to remove excess pericardial fluid accumulated due to various pathological processes. Symptomatic pericardial effusions are seen in various infectious processes, malignancies, and autoimmune diseases, after myocardial infarction or radiation therapy, as a response to certain drugs, toxins, and chemotherapeutic agents, and in metabolic derangements such as uremia. The etiology and temporal characteristics of pericardial effusion will determine the approach to pericardiocentesis.

Pericardiocentesis may be performed via several approaches. The procedure may be performed blind or using real-time imaging adjuncts such as transthoracic echocardiography (TTE) or fluoroscopy to reduce the risk of procedural complications. Pericardiocentesis may be performed at the bedside or in the cardiac catheterization lab. The decision on where to perform the procedure and what adjuncts to use is based on the stability of the patient, the comfort of the operator, and the availability of imaging adjuncts.