PERICARDIOCENTESIS – Definition, Purpose, Findings, Indications, Client Preparation, Procedure, Specific Precautions, After Care, Complications, Abnormal Findings and Contraindications (NURSING PROCEDURE)
Pericardiocentesis is a diagnostic and therapeutic procedure in which the pericardial space is accessed with a needle or cannula and fluid is aspirated. For diagnostic purpose, the fluid is then analyzed. Normally, the pericardial space between the visceral and parietal pericardium contains approximately 20-50 ml of clear fluid. If the pericardium becomes inflamed or diseased or is disrupted, pericardial effusion may occur. As fluid builds up in the pericardial space, cardiac tamponade may result
DEFINITION
Pericardiocentesis, which involves the aspiration of fluid from the pericardial sac with a needle, may be performed for therapeutic and diagnostic purposes
PURPOSE
Analysis of pericardial fluid is performed to determine the cause of and appropriate therapy for acute pericarditis, subacute effusive-constrictive pericarditis, neoplastic pericardial diseases and pericardial effusions of unknown cause
FINDINGS
- Bacterial
- Viral
- Fungal infections
- Malignancies
INDICATIONS
- Suspected and unsuspected cardiac dysrhythmia (supraventricular and ventricular)
- Correlation of symptoms with the ECG tape
- Mitral valve
CLIENT PREPARATION
- Explain the procedure to the client
- Obtain informed consent for this procedure
- Check the laboratory work for bleeding problems
- Obtain the baseline ECG if ordered
- Document baseline vital signs and heart sounds
- Take medication history to check for anticoagulant use
- Restrict fluids and food intake for at least 4-6 hours
- Obtain IV access for infusion of fluids and cardiac medications if required
- Administer premeditations, such as sedation as prescribed
- Shave site if necessary
PROCEDURE
- Position the client. Usually a recumbent position is used, with the torso and head elevated 30-45 degrees
- An area in the fifth to sixth intercostals space at the left sternal margin (or subxiphoid) is prepared and draped
- After skin anesthesia is performed, a large-bore pericardiocentesis needle is placed on a 50 ml syringe and introduced into the pericardial sac
- An electrocardiograph lead is often attached by a clip to the needle to identify and ST segment elevations, which may indicate penetration into the epicardium
- Pericardial fluid is aspirated and placed in multiple specimen containers
- Some clients who have recurring cardiac tamponade may require placement of an indwelling pericardial catheter for continuous draining for 1-3 days
- With certain types of pericarditis, medications may be instilled during pericardiocentesis
SPECIFIC PRECAUTIONS
- Ensure that an intravenous infusion is present and patent
- Maintain telemetric or cardiac monitoring
- Frequent vital signs should be checked
- Have a defibrillator and emergency drugs on hand
AFTER CARE
- Label and number the specimen tubes that contain the pericardial fluid and deliver them to the appropriate laboratory
- Apply a sterile dressing to the catheter if one has been left for continuing pericardial drainage
- Establish a closed system if continued pericardial drainage is required. This is usually performed via the straight drainage method
- The client may return to pretest activities gradually if vital sign are stable
COMPLICATIONS
- Laceration of the coronary artery or myocardium
- Needle-induced ventricular arrhythmias
- Myocardial infarction
- Pneumothorax caused by inadvertent puncture of the lungs
- Liver laceration caused by inadvertent puncture
- Pleural infection
- Vasovagal arrest
ABNORMAL FINDINGS
- Pericarditis
- Uremia
- Hypoproteinemia
- Congestive heart failure
- Metastatic cancer
- Blunt or penetrating cardiac trauma
- Rupture of ventricular aneurysm
CONTRAINDICATIONS
- Client who are uncooperative, because of the risk of lacerations to the epicardium or coronary artery
- Clients with a bleeding disorder
