Name of the Procedure:

Pericardial drainage (Pericardiocentesis) with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, for patients birth through 5 years of age or any age with congenital cardiac anomaly.

Summary

Pericardial drainage is a medical procedure that involves the removal of excess fluid from the sac surrounding the heart (pericardium) by inserting a catheter through the skin. This procedure uses imaging guidance, such as fluoroscopy or ultrasound, to ensure accurate placement of the catheter and is performed in young children and patients with congenital heart anomalies.

Purpose

Pericardial drainage is performed to relieve pressure on the heart caused by fluid accumulation in the pericardial sac (pericardial effusion). The goal is to prevent or treat cardiac tamponade, a life-threatening condition where the heart's ability to pump blood is compromised due to the pressure from the excess fluid.

Indications

• Symptoms of cardiac tamponade (e.g., low blood pressure, rapid heart rate, difficulty breathing).
• Diagnosed pericardial effusion via echocardiogram or other imaging studies.
• Congenital cardiac anomalies associated with pericardial effusion.

Preparation

• The patient may need to fast for a few hours before the procedure.
• Certain medications may need to be adjusted or withheld.
• Pre-procedure diagnostic tests may include blood tests, chest X-rays, and echocardiograms.

Procedure Description

1. Preparation: The patient is positioned properly, and the skin over the insertion site is cleaned and sterilized.
2. Anesthesia: Local anesthesia is applied to the insertion site. Sedation or general anesthesia may be used, particularly in young children.
3. Imaging Guidance: Fluoroscopy or ultrasound is used to guide the catheter placement.
4. Catheter Insertion: A needle is inserted through the skin into the pericardium, followed by the insertion of an indwelling catheter to drain the excess fluid.
5. Monitoring: Continuous monitoring of the patient’s vital signs and heart function is maintained throughout the procedure.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Pericardial drainage is usually performed in a hospital setting, either in a cardiac catheterization lab or an operating room equipped with imaging technologies.

Personnel

• Cardiologist or pediatric cardiologist
• Interventional radiologist or ultrasound technician
• Anesthesiologist or sedation specialist
• Nursing staff specialized in cardiac care

Risks and Complications

• Infection at the insertion site
• Bleeding or damage to the blood vessels
• Puncture of the heart or lungs
• Re-accumulation of fluid
• Allergic reactions to medication

Benefits

• Immediate relief of symptoms caused by pericardial effusion.
• Increased heart functionality and stability.
• Prevention of complications such as cardiac tamponade.

Recovery

• The patient is monitored in the hospital for several hours or overnight.
• Post-procedure pain management may include oral or intravenous medications.
• Follow-up echocardiograms or check-ups might be required to ensure no re-accumulation of fluid.
• Activity restrictions may be advised for a short period.

Alternatives

• Medical management with anti-inflammatory drugs.
• Surgical creation of a pericardial window to allow continuous drainage.
• The choice of alternative depends on the patient’s overall health, severity of the effusion, and underlying conditions.

Patient Experience

During the procedure, the patient may feel slight pressure or discomfort at the insertion site. Post-procedure, there might be mild soreness managed with pain relievers. The use of sedation or anesthesia is tailored to minimize discomfort and anxiety, especially for young children. Continuous monitoring and supportive care ensure patient safety and comfort.