Pericardial Drainage

Pericardial drainage (pericardiocentesis) is done to find the cause of fluid buildup around the heart and to relieve pressure on the heart. The tissue sac that surrounds the heart is called the pericardium. It protects the heart and parts of the major blood vessels connected to the heart. Normally, there is a small amount of fluid between this sac and the heart. This fluid surrounds and helps cushion the heart. It helps reduce friction between the heart and other structures in the chest when the heart beats.

Some diseases allow too much fluid to collect within the pericardium (pericardial effusion). Excess fluid can prevent normal filling of the heart, which can reduce the heart's ability to pump blood (cardiac tamponade).

Pericardial drainage may be done to find the cause of a pericardial effusion. During this test, a needle is inserted through the chest wall and the pericardium to remove a sample of the fluid. The fluid is sent to a laboratory where it is measured and checked for blood, microorganisms (such as bacteria, fungi, or viruses), white blood cells, sugar (glucose), and cancer cells. In some cases, the pericardial fluid may be checked for other substances (such as carcinoembryonic antigen, or CEA).

Pericardial drainage may also be done to help relieve pressure on the heart. It is sometimes done in an emergency if a serious injury has occurred, such as a gunshot or stab wound to the chest or a massive heart attack. In these circumstances, blood or fluid can build up very rapidly in the pericardium. An emergency pericardial drainage can be done to remove the blood or excess pericardial fluid surrounding the heart.

Pericardial drainage is done to:

• Relieve pressure on the heart.
• Find the cause of pericardial effusion.
• Remove blood or excess fluid after a heart attack or a serious injury, such as a gunshot or stab wound.

Tell your doctor if you:

• Have allergies to any medicines, including anesthetics.
• Take any medicines, particularly antibiotics or blood thinners (anticoagulants).
• Have had bleeding problems.

Unless the procedure is being done in an emergency, you will be asked to sign a consent form. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

You may not be able to eat or drink for several hours before the test. Some blood tests, including those to check for anemia and blood-clotting problems, may be done before the test.

Because this is a test involving your heart, you may have to stay overnight in the hospital to be monitored closely. If a drain is inserted during the test, you may have to stay for several days.

A diagnostic pericardial drainage is usually done in a cardiac procedure room. If the drainage is being done to relieve pressure on the heart, it may be done in an emergency room or in your hospital room. This procedure is normally performed by a cardiologist, a cardiovascular surgeon, or an emergency medicine doctor.

During the test, your heart is monitored using electrocardiography. You will have an intravenous (IV) line for any medicine that may need to be given during the test. You may be given a mild sedative to help you relax.

In nonemergency situations, you will lean back at an angle on the bed or table. Your chest will be shaved (if necessary), cleaned with an antiseptic solution, and covered with sterile drapes.

A local anesthetic will be injected to numb the skin and deeper tissues, and then a long thin needle will be carefully inserted just below your breastbone. In some cases the needle is inserted between your ribs on the left side, over your heart. The needle is then slowly advanced through the pericardial sac into the pericardial space. Fluid is removed and sent to the laboratory. At different times during the procedure, you may be asked to hold your breath. You must remain very still throughout the procedure. An electrocardiography machine may be attached by a wire to the needle to help the doctor guide the needle into the pericardial space. In some hospitals an echocardiogram is done at the same time to help the doctor follow the location of the needle during the procedure, or an X-ray camera may be used to guide the procedure.

After some or all of the fluid is removed, the needle is withdrawn and pressure is applied to the injection site for several minutes to stop any bleeding. Fluid also may be drained through a thin catheter over a period of hours.

This procedure takes 10 to 20 minutes. After the test, you will have a chest X-ray to check for possible puncture and collapse of your left lung. You will be closely observed for several hours, with frequent checks of your blood pressure, heart rate, and breathing rate.

You will feel a brief stinging pain when the local anesthetic is injected. When the needle is inserted into the pericardial sac, you may feel pressure. You may also have some irregular or "skipped" heartbeats during the test. Tell your doctor right away if you have severe chest pain or feel short of breath during or after the procedure.

Pericardial drainage can be a risky procedure, though few serious or life-threatening complications occur when it is performed by an experienced doctor. It is possible for the needle to puncture your heart or one of your blood vessels. In rare instances, the needle may also puncture your lung, your liver, or your stomach. These complications may require surgery to repair.

If the needle touches your heart, you may have an irregular heartbeat (arrhythmia), but the irregularity usually stops when the needle is removed. In rare instances, this type of arrhythmia can cause death. There is also a slight chance of spreading infection from the skin to the pericardial space when the needle is inserted.

After the test

After leaving the hospital, call 911 or other emergency services immediately if you have:

• Chest pain or symptoms of a heart attack.
• Moderate to severe trouble breathing.
• Signs of shock.

Call your doctor immediately if you:

• Vomit blood.
• Have a fever.
• Are short of breath.
• Feel dizzy.

Pericardial drainage (pericardiocentesis) is done to find the cause of fluid buildup around the heart and to relieve pressure on the heart. The excess fluid removed during the pericardial drainage will be sent to a laboratory for analysis. Some results will be available within hours, while others may take days or weeks.

Abnormal values

A buildup of pericardial fluid may be caused by:

• Swelling (inflammation) of the sac that surrounds the heart (pericarditis).
• Infection from a virus, bacteria (such as Mycobacterium tuberculosis, the bacterium that causes tuberculosis), or fungi. Viruses are a common cause of pericarditis.
• Other diseases, such as cancer, rheumatoid arthritis, lupus, kidney failure, or hypothyroidism.
• Blood may be present after a heart attack with possible rupture of the heart muscle, a dissecting aortic aneurysm, recent surgery, injury, or cancer.

Reasons you may not be able to have the test or why the results may not be helpful include:

• Recent use of antibiotics.
• You have a bleeding disorder or if you are taking blood thinners (anticoagulants).

• In some cases, a small sample of tissue may be removed and examined under a microscope (biopsy) to identify certain diseases of the pericardium. This surgery will be done under general anesthesia.
• An echocardiogram may be done at the same time as pericardial drainage. For more information, see the medical test Echocardiogram.

Other Works Consulted

• Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis: Mosby.