Pericardiocentesis (PCC), also called pericardial tap, is a medical procedure where fluid is aspirated from the pericardium (the sac enveloping the heart).

Anatomy and physiology

The pericardium is a fibrous sac surrounding the heart composed of two layers: an inner visceral pericardium and an outer parietal pericardium. The area between these two layers is known as the pericardial space and normally contains 15 to 50 mL of serous fluid. This fluid protects the heart by serving as a shock absorber and provides lubrication to the heart during contraction. Cardiac tamponade is a medical emergency in which excessive accumulation of fluid within the pericardium (pericardial effusion) creates increased pressure. This prevents the heart from filling normally with blood. This can critically decrease the amount of blood that is pumped from the heart, causing obstructive shock, which can be lethal. The removal of the excess fluid reverses this dangerous process, and is often the first treatment for cardiac tamponade due to its speed.

Relative contraindications

Long-term drainage

Pericardiocentesis is a one-off procedure, which may not be appropriate for long-term drainage. In cases where longer term drainage is needed, the cardiothoracic surgeon can create a pericardial window. This involves the removal of a section of the pericardium, and the placement of a chest tube.

Aortic dissection

Pericardiocentesis is not appropriate if cardiac tamponade is associated with aortic dissection. For patients that are awake, a local anaesthetic is applied.

  • In the past, the standard location was through the infrasternal angle and is also called subxiphoid approach.
  • Another location is through the 5th or 6th intercostal space at the left sternal border at the cardiac notch of the left lung, and is also called as parasternal approach. The most common complications are lacerations of coronary arteries, and puncture of the left ventricle (with associated bleeding from both). Echocardiograms can help to identify complications.

References

  • Trauma Man: Images of pericardiocentesis being performed on a simulator
  • Cardiac Surgery in the Adult: Pericardial disease