As a general rule, pericardiocentesis refers to a medical procedure that affects the pericardium. At, liquid is extracted from the pericardial sac using a fine needle for this.
Also, the pericardium It is a kind of bag that surrounds heart and consists of two wraps or layers. Therefore, a small compartment between our lungs is located inside the mediastinum (middle).
It also covers the beginning of several major blood vessels that start from this organ. In this way, we can differentiate between the fibrous pericardium and the serosal.
The fabric that makes the fibrous pericardium (makes up the external part) is resistant and presents a conical shape. In addition, this layer is firmly attached to the diaphragm through the pericardiofrenic ligament. In this way, the heart maintains its position even though we change body posture. It is also responsible for limiting the expansion or distension of the heart.
The serous pericardium (represents the internal area) consists of two envelopes: the parietal and visceral pericardium. In this case, the visceral layer is directly on the myocardium (the cardiac muscle). However, the parietal layer is located on the inner side of the fibrous pericardium.
On the other hand, between these two wraps There is a space called pericardial cavity. In it there is a fluid that facilitates the displacement of the cardiac layers. Thanks to this lubricating liquid, the heart can carry out its movements in a normal way.
How is pericardiocentesis performed?
First, the medical team will select the place where the intervention will be performed surgical As a general rule, it is done in the Intensive Care Unit or ICU. There are occasions when it is applied even in the patient's room.
Then, the specialists will place an intravenous line in an arm of the subject . In this way, they can administer to the patient liquids or medications if needed. They are usually recommended if a arrhythmia (disturbance of the sinus heart rate). They can also be used in case of decreased blood pressure during the procedure.
Later, the region below the sternum will be cleansed and a local anesthetic will be applied . Therefore, the patient will not be bothered by the entry of the needle.
With the help of a echocardiogram , doctors will guide the needle to the right position thanks to ultrasound. Once correctly positioned, the needle is replaced by a catheter or a catheter. It is a small tube through which the liquid will drain into a small container.
The catheter is often left in this position to continue to draw fluid for several hours. During this medical method, the vital signs of the patient and how he responds to the operation will be controlled at all times.
However, in case of complications it is possible that the medical team decides to perform a pericardiocentesis surgical In this case, the technique is more invasive and the patient must undergo anesthesia to carry it out. It is chosen to drain the fluid into the abdominal or pleural cavity to remove it more easily.
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Is preparation necessary before performing pericardiocentesis?
The doctor will tell you series of guidelines you must follow before the intervention . Generally, patients should avoid eating or drinking the hours before surgery. They must also sign the consent of the operation and the understanding of the risks involved.
What can the patient feel?
As a general rule the subject will feel pressure as the needle moves through the chest. Also, there are patients who feel a chest pain that can be counteracted with the use of analgesics.
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In what cases is it recommended?
This medical examination of the pericardial fluid can be carried out for several reasons. For example, We can highlight the following clinical cases:
- Pericardial effusion . It is used to identify the cause of this disorder whether recurrent or acute. It consists of the accumulation of fluid in the pericardial cavity. This situation creates pressure on the heart and alters its functioning.
- Cardiac tamponade . Doctors choose this method also as a treatment for this problem that can be fatal for the patient.
- LeWinter MM, Hopkins WE. Pericardial diseases. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015: chap 71.
- Little WC, Oh JK. Pericardial diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 77.
- Kilpatrick ZM, Chapman CB. On Pericardiocentesis. Am J Cardiol . 1965; 16: 722-8. Medline
- Bishop LH, Estes EH, McIntosh HD. The electrocardiogram as a safeguard in pericardiocentesis. JAMA . 1956; 162: 264-5.
- Becker RM. Management of pericardial effusion [letter]. Am J Cardiol . 1980; 45: 188-9. Medline