Test Overview

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 (What is a PDF document?).

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.

Risks

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:

Call your doctor immediately if
you:

  • Vomit blood.
  • Have a
    fever.
  • Are short of breath.
  • Feel dizzy.
  • Have lower-than-normal blood pressure.

Results

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.

Pericardial drainage
Normal:

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.

Abnormal:

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.

Abnormal values

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 Places To Get Help

Organizations

American Heart Association
www.heart.org

National Heart, Lung, and Blood Institute (U.S.)
www.nhlbi.nih.gov

Related Information

References

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.

Credits

ByHealthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC – Cardiology, Electrophysiology
Martin J. Gabica, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer George Philippides, MD – Cardiology

Current as ofOctober 5, 2017