What is pericardiocentesis?

Pericardiocentesis, also called pericardial tap, is an invasive procedure that uses a needle and a catheter to remove fluid from the sac around the heart. The fluid is then sent to a laboratory and tested for signs of infection or cancer.

The heart is surrounded by a membrane covering called the pericardial sac. This sac normally contains a small amount of fluid to cushion and lubricate the heart as it contracts and expands.

A condition called pericardial effusion can occur if too much fluid gathers in the pericardial cavity.

The rate of pericardial fluid accumulation is important. When there is rapid or excessive build-up of fluid or blood in the pericardial cavity, the resulting compression on the heart impairs the pumping action of the vascular system.

What pericardiocentesis treats

Pericardiocentesis is used to remove abnormal amounts of fluid that may be the result of:

  • Pericarditis – Infection caused by inflammation of the pericardial sac
  • Trauma, such as an abnormal collection of blood due to an accident
  • Surgery or invasive heart procedures
  • Heart attack
  • Congestive heart failure – When the heart loses its pumping capability due to a heart condition
  • Kidney (renal) failure
  • Cancer

For emergency situations, pericardiocentesis can be used to remove the excess accumulations of blood or fluid from the pericardial sac. For diagnostic purposes, pericardiocentesis may be advised in order to obtain fluid samples from the sac for laboratory analysis.

What to expect during pericardiocentesis

Preparing for your procedure

First, you’ll meet with your doctor to discuss your medical history, the medicines you take and any questions you have about the procedure.

Pericardiocentesis can be performed in an emergency room, ICU, or at your bedside. Before the procedure you have an echocardiogram and basic blood analysis.

You receive an IV line for sedation or other medications and an electrocardiogram (EKG/ECG) to monitor heart activity. You must lie flat on the table, with the body elevated to a 60-degree angle. If the test is elective, then food and water restriction is recommended for six hours before the test.

During your procedure

A local numbing medication is applied to the area just below your breastbone. Your surgeon inserts a needle and guides it into the pericardial sac. An echocardiogram is used to help position the needle and monitor fluid drainage. Electrocardiographic leads may also be used to help with positioning.

Once the needle has reached the correct area, it is removed and replaced with a tube called a catheter; the excess fluids from the pericardial sac drain through this catheter. The procedure takes about 20 to 60 minutes. Usually, the pericardial catheter is left in place so drainage may continue for several hours.

Surgical pericardiocentesis may be necessary in difficult cases. In this procedure, the fluid is drained through a more invasive procedure that may require general anesthesia.

After your procedure

The puncture site, (or if a catheter is fixed in place, the catheter site), should be inspected regularly for signs of infection such as redness or swelling. Vital signs such as blood pressure and pulse are monitored following the procedure. Your physician will give you instructions for at-home care.

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