Pericardiocentesis

The sac around the heart

The heart sits inside a thin, two-layered sac called the pericardium. Normally there is only a small amount of fluid between the layers. When more fluid collects, it is called a pericardial effusion. Causes include infections (including tuberculosis), kidney failure, an underactive thyroid, cancer, inflammatory conditions, and after heart surgery or a heart attack. Sometimes no cause is found.

When is drainage needed?

A small effusion may only need treatment of its cause and repeat echo checks. Drainage is usually advised when:

• The fluid is pressing on the heart and stopping it from filling properly. This is called cardiac tamponade, and it is an emergency. Signs include breathlessness, a fast pulse, low blood pressure, dizziness or fainting.
• The fluid needs testing to find the cause.
• A large effusion is not settling with treatment.

How it is done

1. You lie propped up at an angle. The heart and fluid are seen with echocardiography to choose the safest spot, usually just below the breastbone or on the chest wall.
2. The skin is numbed with local anaesthesia; you stay awake.
3. A needle is guided into the fluid under echo, and sometimes X-ray, guidance. A wire is passed and a thin soft tube (drain) is placed.
4. Fluid is drained and samples are sent for tests. The drain may be left in for a short time to let more fluid come out.

Before and after

Tell the doctor about blood thinners, bleeding problems and allergies. In an emergency, these checks are done quickly alongside treatment. Afterwards, your pulse, blood pressure and drain output are monitored, and echo is repeated. Treating the underlying cause matters, as fluid can come back.

When to seek help

After going home, return promptly if breathlessness, chest pain, dizziness or fever comes back, or if the drain site is red or leaking. See emergency signs.

Whether drainage is needed is decided only after examination and echo reports. This page is for understanding, not a substitute for consultation.