Pericardiocentesis
Synonym(s): Pericardial drainage
Introduction
- There is a potential space between the myocardium and the pericardium (the pericardial sac).
- This may become distended with fluid.
- Pressure within the pericardial sac compromises cardiac function (cardiac tamponade) - particularly by causing collapse of the thinner-walled right ventricle.
- Cardiac tamponade → acute congestive heart failure Heart: congestive heart failure.
Uses
- Drainage of pericardial fluid:
- Idiopathic pericardial effusion (hemorrhage) Effusion: overview.
- Pericardial/heart base tumors Pericardium: neoplasia (heartbase tumor) → transudation or hemorrhage Pericardium: idiopathic hemorrhage.
- Hemorrhage (warfarin).
- Septic pericarditis (very rare) Pericardial disease.
Advantages
- Life-saving.
- Minimally invasive procedure when correctly performed.
- Produces rapid benefit to patient.
Disadvantages
- Risk of lacerating myocardium or coronary arteries.
- May be unable to drain all fluid from pericardial sac.
- Risk of recurrence of fluid accumulation.
Technical problems
- Some experience of the procedure and moderate dexterity is required.
Alternative techniques
- Pericardectomy- but requires thoracotomy Thorax: thoracotomy (intercostal) and is an invasive procedure.
- Not appropriate in acute cases as cardiac function may be insufficient to tolerate general anesthesia.
Time required
Preparation
- Radiography Radiography: thorax may suggest pericardial effusion.
- Preferably ultrasonography should be used to confirm pericardial fluid .
- Place intravenous catheter to allow drug and fluid administration if necessary.
Procedure
- 10-30 minutes (depending on quantity of fluid and ease with which it can be drained).
Decision taking
Criteria for choosing test
- If cardiac function is compromised by presence of fluid then drainage is indicated.
- Must confirm fluid presence. Cardiomegaly due to primary heart disease (eg myocardial or valvular disease) can be confused with pericardial fluid.
Risk assessment
- Small risk associated with procedure is outweighed by likelihood of fatality if condition untreated.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
Other sources of information
- Tobias A H (2010)Pericardial diseases.In: Ettinger S J, Feldman E CTextbook of Veterinary Internal Medicine.7th edn. Saunders Elsevier. Chapter 253, pp 1342-1352.
- Kienle R D, Kittleson M D (2005)Pericardial disease and cardiac neoplasia.In:Small Animal Cardiovascular Medicine. St Louis: Mosby.
- Sisson D, Thomas W (1999)Pericardial disease and cardiac tumours.In: Fox P R, Sisson D, Moise N STextbook of Canine and Feline Cardiology. 2nd edn. W B Saunders Company, Philadelphia. Chapter 29, pp 679-701.