33016 Pericardiocentesis, including imaging guidance, when performed

Name of the Procedure:

Pericardiocentesis (Pericardial Tap)

Summary

Pericardiocentesis is a medical procedure that involves inserting a needle into the pericardium (the sac surrounding the heart) to remove excess fluid. This procedure can help alleviate symptoms and diagnose the cause of fluid accumulation around the heart.

Purpose

Pericardiocentesis addresses the accumulation of fluid in the pericardial sac, a condition known as pericardial effusion. The goals are to relieve pressure on the heart, improve cardiac function, and obtain fluid samples for diagnostic purposes.

Indications

• Symptoms like chest pain, shortness of breath, or fatigue due to pericardial effusion.
• Diagnosing the cause of pericardial effusion, such as infections, malignancies, or inflammatory diseases.
• Signs of cardiac tamponade, where pressure from fluid buildup impairs heart function.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications may need to be adjusted or paused, particularly blood thinners.
• Pre-procedure imaging tests such as echocardiograms to locate the fluid and guide the procedure.

Procedure Description

1. The patient is positioned appropriately, often reclining at a 30 to 45-degree angle.
2. Skin preparation and local anesthesia are administered at the insertion site.
3. Using imaging guidance (e.g., echocardiography or fluoroscopy), a needle is carefully inserted into the pericardial sac.
4. Fluid is aspirated and may be collected for laboratory analysis.
5. Once sufficient fluid is removed, the needle is withdrawn, and the site is dressed.

Tools/Equipment:

• Sterile needle and syringe
• Imaging guidance equipment
• Local anesthetics

Anesthesia:

• Typically local anesthesia; sedation may be used depending on the patient's condition.

Duration

The procedure usually takes 30 minutes to an hour.

Setting

Performed in a hospital setting, often in a cardiac catheterization lab, operating room, or intensive care unit.

Personnel

• Cardiologist or a trained interventional radiologist
• Nurses and possibly an anesthesiologist

Risks and Complications

• Infection at the puncture site
• Bleeding or hematoma
• Injury to the heart or surrounding structures
• Rarely, cardiac tamponade or severe blood pressure drops

Benefits

• Relief from symptoms like chest pain and shortness of breath
• Improved cardiac function
• Diagnostic information to guide further treatment

Recovery

• Patients are monitored for several hours for any signs of complications.
• Instructions on activity restrictions and care for the puncture site.
• Follow-up appointments to assess recovery and discuss lab results from aspirated fluid.

Alternatives

• Medications to manage symptoms and underlying causes.
• Surgical procedures, such as a pericardial window, for recurrent or severe cases.

Pros and Cons:

• Medications may not be effective for all patients and don’t provide diagnostic information.
• Surgical options are more invasive with longer recovery times but may be necessary for recurrent effusions.

Patient Experience

During the procedure, patients may feel pressure or discomfort at the insertion site. Local anesthesia minimizes pain, but there might be soreness afterward. Sedation can help manage anxiety. After the procedure, discomfort is generally mild and manageable with pain relief measures.