Pericardiocentesis is a procedure where a healthcare provider inserts a needle into the pericardium, a pouch that surrounds your heart. This procedure has life-saving potential when you have pericardial effusion (too much fluid in the pericardium) and cardiac tamponade (when your heart doesn’t have enough room to beat because of fluid buildup).
Pericardiocentesis (pair-ick-arr-dee-oh-sen-tee-sis) is a procedure that involves draining fluid from around your heart. It’s often an emergency treatment for cardiac tamponade, a life-threatening condition that can stop your heart.
This procedure involves inserting a needle into your chest until the tip of the needle is inside your pericardium. Once there, providers can use the needle to drain fluid directly or place a drain that can remove fluid slowly over time.
Your heart sits inside the pericardium, a liquid-filled pouch that holds your heart in place and cushions it from outside movement. Under normal circumstances, there’s plenty of room in the pericardium. That means your heart can expand and fill up with blood between heartbeats. Pericardial effusion is when the pericardium fills up with too much fluid, which means there’s less space for your heart to expand between heartbeats.
When an effusion happens slowly, your pericardium has time to stretch and accommodate the additional fluid. When one happens quickly, your pericardium doesn’t have time to stretch, and the fluid will put more and more pressure on your heart. That causes cardiac tamponade, which is when your heart’s chambers don’t have room to expand and fill up, so your heart pumps less blood. Cardiac tamponade is a medical emergency because it can make your heart stop, which will be deadly within minutes to hours.
Depending on the circumstances, pericardiocentesis is a potential emergency treatment, or it can happen in non-emergency situations. In emergencies, pericardiocentesis treats either cardiac tamponade or severe pericardial effusions that will cause cardiac tamponade.
Common causes of pericardial effusion and cardiac tamponade that would result in your needing treatment with pericardiocentesis include:
Pericardiocentesis is a relatively common procedure. More than 25,000 of these procedures happen each year in the United States.
After a provider diagnoses you with either a pericardial effusion or cardiac tamponade, they'll determine how severe your condition is and the best way to treat it. Local anesthesia is part of the process and happens at the very beginning of the procedure (see the “What happens during the procedure?” heading below).
The preparation for this procedure depends on whether or not it’s an emergency. In cases where it’s not an emergency — such as when you have an effusion that’s slow-growing — your healthcare provider can schedule the procedure. In most cases, except in the direst emergencies, you’ll receive local anesthesia.
On the day of the procedure, you'll need to fast (not eat) starting eight hours before the procedure (you can have clear liquids up to two hours before the procedure starts).
They’ll also do the following:
Pericardiocentesis is a procedure that involves several healthcare providers from different backgrounds. It will likely involve one or more doctors, nurses, imaging technicians and more.
Before inserting the needle, the healthcare provider performing this procedure will work with an imaging technician to find the safest, simplest way to reach the pericardium. The most common type of imaging is ultrasound (echocardiogram), which is safe and easy to perform at the time of the procedure. Imaging is especially important because it helps the provider insert the needle right where it needs to go.
Unless you are in immediate danger of your heart stopping, your provider will use a local anesthetic to numb the area just before they insert the needle. They may also use a scalpel to make a small cut on your skin to make it easier to insert the needle.
Depending on where the fluid is in your pericardium, there are several places to insert the needle. The most common location is:
Less common entry points are:
Once they insert the needle, they'll angle it so that it enters your pericardium, but not your heart. Once the tip of the needle is in the pericardium, the provider can start drawing out the extra fluid inside.
Depending on how much fluid is inside your pericardium, it may take only minutes to remove enough fluid. If there's a lot of fluid, they may insert a catheter tube to drain fluid out more slowly.
Once they've drawn out enough fluid, your provider can pull the needle (or catheter) out, or they can leave a drainage catheter in place for a day or two to remove more fluid. When removing the needle or drain, they'll finish the procedure by bandaging the spot.
After the procedure, your healthcare provider may want to have the fluid taken from inside the pericardium tested. That can help figure out why you had fluid buildup in the first place. They will also repeat an ultrasound (echocardiogram) to confirm the fluid is all gone. If a drain is left in place, they will repeat an ultrasound daily to confirm the fluid is gone prior to pulling the drainage tube out.
Pericardiocentesis is a life-saving procedure when your heart is under pressure from fluid around it. It can also help collect fluid samples that will show why it happened in the first place, which can help healthcare providers treat the underlying problem. This procedure is also useful because it's faster and less invasive than surgery. That means it's usually a better, faster option when you have severe symptoms from cardiac tamponade and you're at risk for your heart to stop.
Complications related to pericardiocentesis happen in about 5% to 40% of cases. The risk of complications is lowest when imaging like echocardiogram or fluoroscopy helps the provider “see” where to direct the needle. In extreme emergencies, it’s possible to do this procedure without imaging help. However, this is very rare and should only happen when there’s no other option.
Even with imaging, the procedure involves inserting a needle very close to several of your vital organs and major blood vessels. That means there’s a risk of injuring any of the following:
Any kind of medical procedure that needs to pass through your skin also creates the risk of infection. When these infections spread, it can lead to an overwhelming reaction by your immune system. That overreaction, known as sepsis, is a life-threatening medical emergency.
Most people will start to feel better quickly while the fluid removal happens or immediately after. The overall recovery time also depends on the severity of your case, what caused it (especially if it happened because of an injury) and any other medications or treatments you received for it. Your healthcare provider is the best person to tell you what to expect when it comes to your recovery and when you can resume your normal activities.
Your healthcare provider will schedule follow-up visits to ensure you don't have any complications or additional need for treatment. Some people will need more than one procedure because pericardial effusions can happen more than once. This is especially the case for certain cancers, infections like tuberculosis or other conditions.
Several symptoms or other indications mean you need medical attention if you've recently had this procedure.
The symptoms of cardiac tamponade include:
You should also go to the hospital immediately if you have any infection symptoms. These can be a sign of sepsis, a life-threatening condition that's as serious as a heart attack or stroke. The symptoms of sepsis include:
A note from Cleveland Clinic
Pericardiocentesis is a common medical procedure that treats severe pericardial effusion and cardiac tamponade. Thanks to advances in treatment techniques, technology, and healthcare provider education and training, this procedure usually has good outcomes. While it does have some risks, the potential for this procedure to save lives almost always outweighs any risks.
Last reviewed by a Cleveland Clinic medical professional on 02/26/2022.
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