The patient undergoing pericardiocentesis is positioned supine with the head of the bed raised between a 30 and 60 degree angle. Other relative contraindications include coagulopathies, thrombocytopenia, myocardial rupture, severe pulmonary hypertension, prior thoracoabdominal surgery, prosthetic heart valves, pacemakers and other cardiac devices, inadequate visualization of the effusion on ultrasound during the procedure, and situations in which more appropriate treatment options are available. Pericardiocentesis is not usually useful for diagnosis of more minor pericardial effusion. In this case, there is a high risk of the procedure worsening this aortic dissection by causing haemorrhage. Pericardiocentesis is not appropriate if cardiac tamponade is associated with aortic dissection. This involves the removal of a section of the pericardium, and the placement of a chest tube. In cases where longer term drainage is needed, the cardiothoracic surgeon can create a pericardial window. Pericardiocentesis is a one-off procedure, which may not be appropriate for long-term drainage. Relative contraindications Long-term drainage There are no absolute contraindications to pericardiocentesis in emergency situations where a patient is hemodynamically unstable. autoimmune conditions, such as lupus and rheumatoid arthritisĬontraindications Absolute contraindications.Fluid may be analyzed to differentiate a number of conditions, including: ![]() Pericardiocentesis can also be used to analyze the fluid surrounding the heart. Diagnostic pericardiocentesis Analysis of pericardial fluid Removal of some of this fluid reduces pressure on the heart. There may be a normal amount of pericardial fluid, but inflammation still causes compression of the heart. Pericardiocentesis can relieve the symptoms of pericarditis. The removal of the excess fluid reverses this dangerous process, and is often the first treatment for cardiac tamponade due to its speed. This can critically decrease the amount of blood that is pumped from the heart, causing obstructive shock, which can be lethal. This prevents the heart from filling normally with blood. Cardiac tamponade is a medical emergency in which excessive accumulation of fluid within the pericardium ( pericardial effusion) creates increased pressure. Pericardiocentesis can be used to diagnose and treat cardiac tamponade. Therapeutic pericardiocentesis Cardiac tamponade treating tamponade) and those that are diagnostic (i.e. Indications for performing pericardiocentesis can be divided into those that are therapeutic (i.e. ![]() If accumulation of fluid is slow and occurs over weeks to months, the pericardial sac can tolerate several liters of additional fluid without substantially hindering the ability of the heart to pump. This pressure can significantly hinder the ability of the heart to contract, leading to cardiac tamponade. ![]() However, once a critical volume is reached, even small amounts of extra fluid can rapidly increase pressure within the pericardium. The elastic nature of the pericardium allows it to accommodate a small amount of extra fluid, roughly 80 to 120 mL, in the acute setting. This fluid protects the heart by serving as a shock absorber and provides lubrication to the heart during contraction. The area between these two layers is known as the pericardial space and normally contains 15 to 50 mL of serous fluid. The pericardium is a fibrous sac surrounding the heart composed of two layers: an inner visceral pericardium and an outer parietal pericardium. Pericardiocentesis ( PCC), also called pericardial tap, is a medical procedure where fluid is aspirated from the pericardium (the sac enveloping the heart).
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