Pericardiocentesis is a procedure that uses a needle to remove fluid from the pericardial sac, the tissue that surrounds the heart.

The procedure is usually done in an intensive care unit's procedure room or even at the bedside.

A health care provider will put an IV into your arm, in case fluids or medicines need to be given through a vein. For example, medication may be given if you have slowing of the heartbeat or a drop in blood pressure during the procedure.

The health care provider will clean an area just below the breastbone and apply a local numbing medication (anesthetic). The doctor will insert a needle and guide it into the pericardial sac. Echocardiography is used to help position the needle and monitor fluid drainage, although electrocardiographic (ECG) leads may also be used to help with positioning.

Once the needle has reached the correct area, it is removed and replaced with a tube called a catheter. Fluid drains through this catheter into containers. Usually, the pericardial catheter is left in place so draining may continue for several hours.

Surgical pericardiocentesis may be necessary in difficult cases. In this procedure, the fluid is drained through a more invasive procedure that may require anesthesia.

You may not be able to eat or drink for 6 hours before the test. You must sign a consent form.

You may feel pressure as the needle enters. Some people have chest pain, which may require pain medication.

This test may be done to remove and examine fluid that is pressing on the heart. It is usually done to evaluate the cause of a chronic or recurrent pericardial effusion.

It may also be done to treat cardiac tamponade.

There is normally a small amount of clear, straw-colored fluid in the pericardial space.

Abnormal findings may indicate the cause of pericardial fluid accumulation, such as:

• Cancer
• Cardiac perforation
• Cardiac trauma
• Congestive heart failure
• Pericarditis
• Rupture of a ventricular aneurysm

• Heart attack
• Infection (pericarditis)
• Irregular heartbeats arrhythmias
• Puncture of the heart muscle, coronary artery, lung, liver, or stomach
• Pneumopericardium (air in the pericardial sac)

LeWinter MM. Pericardial Diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007: Chap. 70.