Pericardiocentesis

Pericardiocentesis
Intervention

ICD-9-CM	37.0
MeSH	D020519
MedlinePlus	003872

In medicine, pericardiocentesis is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart).

Position

The patient undergoing pericardiocentesis is positioned supine with the head of the bed raised to a 30- to 60-degree angle. This places the heart in proximity to the chest wall for easier insertion of the needle into the pericardial sac. Anatomically, the procedure is carried out under the xiphoid process, up and leftwards.^[1]

Process

It is generally done under ultrasound guidance, to minimize complications. There are two locations that pericardiocentesis can be performed without puncturing the lungs.^[2]

One location is through the 5th or 6th intercostal space at the left sternal border at the cardiac notch of the left lung and is also called as parasternal approach.
The other location is through the infrasternal angle and is also called subxiphoid approach.^[3]

Indications

Indications include cardiac tamponade, as well as the need to analyze the fluid surrounding the heart. Cardiac tamponade is a condition in which an accumulation of fluid within the pericardium creates excessive pressure, which then prevents the heart from filling normally with blood. This can critically decrease the amount of blood that is pumped from the heart, which can be lethal. The removal of the excess fluid reverses this dangerous process. Examples of the need for fluid analysis would be to differentiate whether a fluid collection within the pericardium is due to an infection, spread of cancer, or possibly an autoimmune condition.

Similar procedures

In cases where longer term drainage is needed, the cardiothoracic surgeon can create a pericardial window. This involves the removal of a section of the pericardium, and the placement of a chest tube.

External links

Surgery and other procedures involving the heart (ICD-9-CM V3 35–37+89.4+99.6, ICD-10-PCS 02)

Surgery and IC

Heart valves and septa	Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Percutaneous aortic valve replacement Mitral valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock–Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of great vessels Jatene procedure Mustard procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock–Taussig shunt SVC to the right PA Glenn procedure

Cardiac vessels	CHD Angioplasty Bypass/Coronary artery bypass MIDCAB Off-pump CAB TECAB Coronary stent Bare-metal stent Drug-eluting stent Bentall procedure Valve-sparing aortic root replacement

Other	Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure Cox maze and minimaze Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion Left atrial appendage occlusion Cardiotomy Heart transplantation

Diagnostic
tests and
procedures

Electrophysiology

Electrocardiography

Vectorcardiography

Holter monitor

Implantable loop recorder

Cardiac stress test

Bruce protocol

Electrophysiology study

Cardiac imaging

Angiocardiography

Echocardiography

TTE

TEE

Myocardial perfusion imaging

Cardiovascular MRI

Ventriculography

Radionuclide ventriculography

Cardiac catheterization/Coronary catheterization

Cardiac CT

Cardiac PET

sound: Phonocardiogram

Function tests

Pacing

References

↑ Sam, Amir H.; James T.H. Teo (2010). Rapid Medicine. Wiley-Blackwell. ISBN 1-4051-8323-3.
↑ http://www.sonoguide.com/pericardiocentesis.html
↑ http://www.sonoguide.com/pericardiocentesis.html

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