What is the role of pericardiocentesis in the treatment of pericardial effusion?

Updated: Nov 28, 2018
  • Author: William J Strimel, DO, FACP; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

As previously mentioned, pericardiocentesis is used for diagnostic as well as therapeutic purposes. Pericardial fluid drainage can be performed by percutaneous catheter drainage or open surgical approach. Individual patient characteristics (eg, loculated vs circumferential, recurrent pericardial effusion, need for pericardial biopsy and location of pericardial effusion) and local practice patterns aid in deciding the optimal method of drainage.

Percutaneous pericardial fluid drainage (pericardiocentesis) is the most common method used for pericardial fluid removal. It can be performed under fluoroscopic, echocardiographic, or CT guidance.

Echocardiographic pericardial fluid drainage has established itself as the criterion standard technique. In study of 1127 procedures performed on 977 patients, echocardiographic-guided pericardiocentesis was successful in 97%, with 1.2% major and 3.5% minor complications. [33] It also established the extended drainage as a means to reduce the recurrence rate.

Use of a needle that is at least 5cm long and 16-gauge in diameter and that has a short bevel can minimize the risk of complications and should allow for adequate pericardial drainage. A system allowing placement of a catheter over the needle is preferred.

Contrast echocardiography using agitated saline is useful in cases in which bloody fluid is aspirated, to determine if the needle is in the ventricular cavity.

Attaching an ECG electrode to the pericardiocentesis needle is also useful for avoiding myocardial puncture. Electrical activity will be seen on the monitor when the needle comes into contact with atrial or ventricular myocardium. These changes may be delayed, however, and instill a false sense of security in needle placement. Sense of touch and the findings on aspiration should guide the procedure, with the clinician ultimately relying on good clinical sense.

Complications of pericardiocentesis include ventricular rupture, dysrhythmias, pneumothorax, myocardial and/or coronary artery laceration, and infection. Recurrence rates for pericardial effusion within 90 days may be as high as 90% in patients with cancer.


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