In medicine

Medicine

Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

, pericardiocentesis is a procedure where fluid is aspirated from the pericardium

Pericardium

The pericardium is a double-walled sac that contains the heart and the roots of the great vessels.-Layers:...

 (the sac enveloping the heart

Heart

The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...

).

Position

The patient undergoing pericardiocentesis is positioned supine with the head of the bed raised to a 30- to 60-degree angle.This places the heart in proximity to the chest wall for easier insertion of the needle into the pericardial sac

Process

It is generally done under ultrasound

Medical ultrasonography

Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...

 guidance, to minimize complications. There are two locations that pericardiocentesis can be performed without puncturing the lungs.

• One location is through the 5th or 6th intercostal space
  Intercostal space
  The intercostal space is the space between two ribs . Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it.-Structures in intercostal space:* several kinds of intercostal muscle...
  
   at the left sternal border at the cardiac notch of the left lung.
• The other location is through the infrasternal angle
  Infrasternal angle
  The lower opening of the thorax is formed by the twelfth thoracic vertebra behind, by the eleventh and twelfth ribs at the sides, and in front by the cartilages of the tenth, ninth, eighth, and seventh ribs, which ascend on either side and form an angle, the infrasternal angle or subcostal angle,...
  
  .

Indications

Indications include cardiac tamponade

Cardiac tamponade

Cardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium ....

, as well as the need to analyze the fluid surrounding the heart. Cardiac tamponade is a condition in which an accumulation of fluid within the pericardium creates excessive pressure, which then prevents the heart from filling normally with blood. This can critically decrease the amount of blood that is pumped from the heart, which can be lethal. The removal of the excess fluid reverses this dangerous process. Examples of the need for fluid analysis would be to differentiate whether a fluid collection within the pericardium is due to an infection

Infection

An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

, spread of cancer

Cancer

Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

, or possibly an autoimmune condition.

Similar Procedures

In cases where longer term drainage is needed, the cardiothoracic surgeon can create a pericardial window

Pericardial window

A pericardial window is a cardiac surgical procedure to create a fistula - or "window" - from the pericardial space to the pleural cavity. The purpose of the window is to allow a pericardial effusion to drain from the space surrounding the heart into the chest cavity - where the fluid is not as...

. This involves the removal of a section of the pericardium, and the placement of a chest tube.

External links

• Cardiac Surgery in the Adult: Pericardial disease