This video demonstrates the percutaneous pericardiocentesis using anterior chest approach with the use of a micropuncture kit.
Pericardial effusion is a common condition observed in cancer patients where fluid builds up in the pericardial sac, usually caused by cancer or cancer therapy. If fluid compression of the cardiac chamber surpasses a certain threshold, pericardial effusions can become life-threatening, a condition known as cardiac tamponade.
Draining of the pericardial fluid is often needed for diagnostic and therapeutic reasons. Percutaneous pericardiocentesis is the most commonly used technique.
Pericardiocentesis at MD Anderson is typically performed in our cardiac catheterization laboratory where patients hemodynamics can be closely monitored. The procedure is performed under echocardiographic and/or fluoroscopic guidance. Bedside echocardiography helps physicians determine the access site, which can be intercostal or subxyphoid. The site with the shortest distance to the pericardial space is typically used.
Since many of our patients have low platelets and coagulopathy, we typically use a 5 French micropuncture kit to obtain access to the pericardium in order to minimize bleeding risks.
Through echo guidance, the pericardiocentesis needle is inserted into the pericardial sac. Positioning is verified by echocardiography using a saline contrast injection. Fluoroscopy can also be used to confirm needle and guiding wire position within the pericardium. The needle is exchanged to a 5 French micropuncture sheath. Over a long J-wire, a 5 or 8 French pigtail catheter is advanced into the pericardial space and connected to a drainage bag. The draining catheter is then sutured to the chest wall and kept for 3-5 days. 80mL of drained fluid are usually sent to the laboratory for testing.