Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; 6 years and older without congenital cardiac anomaly
CPT4 code
Name of the Procedure:
Pericardial Drainage with Insertion of Indwelling Catheter, Percutaneous Using Fluoroscopy and/or Ultrasound Guidance
Summary
Pericardial drainage with insertion of an indwelling catheter is a minimally invasive procedure used to remove excess fluid from the pericardium (the sac surrounding the heart). This procedure is often guided by fluoroscopy (real-time X-ray) or ultrasound to ensure precision and safety.
Purpose
This procedure addresses pericardial effusion, which is the buildup of excess fluid around the heart. The primary goal is to relieve pressure on the heart, improve cardiac function, and prevent complications such as cardiac tamponade, where fluid accumulation compresses the heart and affects its ability to pump blood.
Indications
- Symptoms like chest pain, shortness of breath, and fatigue indicating pericardial effusion.
- Diagnosis of pericardial effusion via imaging tests like echocardiograms.
- Patients aged 6 years and older without congenital cardiac anomalies.
Preparation
- Patients may need to fast for several hours before the procedure.
- Certain medications may need to be adjusted or discontinued.
- Pre-procedure diagnostic tests might include echocardiography, chest X-ray, and blood tests to assess cardiac function and coagulation.
Procedure Description
- The patient is positioned and prepped in a sterile environment.
- Local anesthesia is administered to numb the area where the catheter will be inserted.
- Using fluoroscopy or ultrasound for guidance, a needle is carefully inserted into the pericardium.
- Once correct positioning is confirmed, an indwelling catheter is inserted through the needle.
- The catheter allows for continuous drainage of pericardial fluid.
- Fluid samples may be sent for laboratory analysis to determine the cause of the effusion.
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
The procedure is usually performed in a hospital setting, either in the radiology department, catheterization lab, or an operating room.
Personnel
- Interventional cardiologist or radiologist
- Nurses
- Anesthesiologist or nurse anesthetist, if sedation is used
- Technicians assisting with imaging equipment
Risks and Complications
- Infection
- Bleeding or hematoma at the insertion site
- Injury to the heart or nearby structures
- Arrhythmias (irregular heartbeats)
- Recurrence of effusion
Benefits
- Immediate relief from symptoms caused by fluid buildup.
- Improved heart function and overall patient well-being.
- Reduction of risk for cardiac tamponade.
Recovery
- Patients are usually monitored in a recovery area for several hours post-procedure.
- Instructions will be provided for catheter care and activity restrictions.
- Follow-up appointments will be scheduled to monitor progress and remove the catheter if it is no longer needed.
- Most patients can resume normal activities within a few days, but heavy lifting or strenuous exercise should be avoided for a while.
Alternatives
- Medication to manage symptoms and underlying causes of effusion.
- Surgical drainage procedures (pericardial window or pericardiectomy).
- Each alternative has its own risk-benefit profile and may be considered based on the patient's condition and medical history.
Patient Experience
Patients may experience a sensation of pressure or discomfort during the procedure. Post-procedure, there may be mild soreness at the catheter insertion site. Pain management can include over-the-counter pain relievers or prescribed medication. Careful monitoring of the catheter site and adherence to follow-up care are crucial for a smooth recovery.