Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance
CPT4 code
Name of the Procedure
Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance.
- Common Name: Pericardial Drainage
- Medical Term: Percutaneous Pericardiocentesis with Catheter Placement
Summary
Pericardial drainage with catheter insertion is a minimally invasive procedure to remove excess fluid from the pericardium, the sac surrounding the heart, using a needle and catheter. It is often guided by CT imaging to ensure precision and safety.
Purpose
This procedure addresses conditions like pericardial effusion, where fluid accumulates around the heart, potentially causing life-threatening complications such as cardiac tamponade. The goal is to relieve pressure on the heart, restore normal cardiac function, and allow for diagnostic analysis of the fluid.
Indications
- Presence of pericardial effusion
- Symptoms of cardiac tamponade (e.g., chest pain, shortness of breath, low blood pressure)
- Diagnostic analysis of pericardial fluid to determine underlying cause (e.g., infection, cancer)
Preparation
- Patients may need to fast for 6-8 hours prior to the procedure.
- Pre-procedure imaging studies (e.g., echocardiogram, CT scan) to assess the fluid and plan the approach.
- Adjustment of certain medications may be required, especially blood thinners.
- Intravenous (IV) line placement for medications and fluids.
Procedure Description
- The patient is positioned on the procedure table, usually lying flat or slightly inclined.
- Local anesthesia is administered to numb the insertion area, and sedation may be given for comfort.
- Using CT guidance, a needle is inserted percutaneously (through the skin) into the pericardial sac.
- Fluid is aspirated to relieve immediate pressure, and an indwelling catheter is placed to allow continuous drainage.
- The catheter is secured in place and connected to a drainage bag, ensuring ongoing removal of excess fluid.
- The procedure is monitored through CT imaging for accuracy and safety throughout.
Duration
Typically, the procedure takes about 60-90 minutes.
Setting
The procedure is generally performed in a hospital's interventional radiology suite or a surgical center equipped with CT imaging technology.
Personnel
- Interventional Radiologist or Cardiologist
- Nurses
- Anesthesiologist or Sedation Nurse (if sedation is used)
- Radiologic Technologist
Risks and Complications
- Infection at the puncture site
- Bleeding or hematoma formation
- Injury to the heart or surrounding structures
- Arrhythmias (irregular heartbeats)
- Rarely, pneumothorax (collapsed lung) and need for emergency surgery
Benefits
- Immediate relief of symptoms caused by pericardial effusion
- Prevention of cardiac tamponade, a potentially life-threatening condition
- Diagnostic information from the pericardial fluid
- Improvement in overall cardiac function and patient well-being
Recovery
- Post-procedure monitoring in a recovery area or ICU
- Instructions for care of the drainage site and catheter
- Follow-up imaging to ensure effective drainage and no recurring effusion
- Expected recovery time varies but usually involves a few days of rest and limited activity
- Follow-up appointments to check for complications and effectiveness of the procedure
Alternatives
- Conservative management with medications (e.g., anti-inflammatory drugs)
- Surgical pericardial window or pericardiectomy (removal of a portion of the pericardium)
- Each alternative has varying degrees of invasiveness, risks, and benefits; percutaneous drainage is often preferred for its minimally invasive nature and quick symptom relief.
Patient Experience
Patients typically experience relief from symptoms shortly after the procedure. Some discomfort at the catheter site and mild pain may be managed with medications. Post-procedure, patients will need to care for the catheter site and may feel some physical limitations while the catheter is in place. Regular follow-up is essential to monitor recovery and ensure no complications.