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 cause fluid to collect within the pericardium. This fluid collection is called 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 into the chest and into 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.
Why It Is Done
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.
How To Prepare
Tell your doctor if you:
- Are allergic to any medicines, including anesthetics.
- Take a blood thinner, or if you have had bleeding problems.
- Are taking antibiotics.
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.
Unless the procedure is being done in an emergency, you will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
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 .
How It Is Done
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 an electrocardiogram (EKG, ECG). 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. Your doctor may use an echocardiogram or EKG to help guide the needle. Or an X-ray camera may be used to guide the procedure.
The doctor then guides a catheter, which is a thin plastic tube, along the needle into the pericardial space. The fluid drains out through the catheter. Some fluid may be saved and sent to a laboratory for tests. At different times during the procedure, you may be asked to hold your breath. You must remain very still throughout the procedure.
This procedure takes 10 to 20 minutes. Sometimes your doctor will let the fluid drain through the catheter for a few hours.
After some or all of the fluid is drained, the catheter is removed, and pressure is applied to the injection site for several minutes to stop any bleeding.
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.
How It Feels
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 might feel pain in another location, such as your shoulder. 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 cases, 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 cases, 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, such as chest pain or pressure, shortness of breath, and nausea.
- Moderate to severe trouble breathing.
- Signs of shock, such as passing out or feeling very dizzy, weak, or less alert.
Call your doctor immediately if you:
- Vomit blood.
- Have a fever.
- Are short of breath.
- Feel dizzy.
- Have lower-than-normal blood pressure.
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.
No bacteria, red blood cells, or cancer cells are present in the pericardial fluid.
No white blood cells (WBCs) are in pericardial fluid.
The pericardial fluid is clear or pale yellow.
Sugar (glucose) is present, but in amounts similar to that found in the blood.
There is less than 50 mL (2 fl oz) of fluid in the pericardial sac.
The pericardial fluid contains blood, bacteria, or cancer cells.
White blood cells are in the pericardial fluid.
The pericardial fluid looks cloudy.
There is more than 50 mL (2 fl oz) of fluid in the pericardial sac.
A buildup of pericardial fluid may be caused by:
- 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 or lupus.
- Blood, which may be present after a heart attack with possible rupture of the heart muscle, a dissecting aortic aneurysm, recent surgery, injury, or cancer.
What Affects the Test
Reasons you may not be able to have the test or why the results may not be helpful include:
- Recent use of antibiotics.
- You take a blood-thinning medicine.
- You have a bleeding disorder.
What To Think About
- 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. To learn more, see the topic Echocardiogram.
Other Works Consulted
- Adler Y, et al. (2015). ESC Guidelines for the diagnosis and management of pericardial diseases. European Heart Journal, 36(42): 2921–2964. DOI: doi/10.1093/eurheartj/ehv318. Accessed April 22, 2016.
- Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
- Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
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