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Pericardiocentesis

Pleural mesothelioma patients deal mostly with symptoms that affect the lungs, including issues such as pleural effusion, a gathering of fluid in the pleural space that surrounds the diseased lung. However, in many cases, as the cancer spreads to other parts of the body, other organs can be affected, including the heart. Similar to the way fluid builds up around the lungs, it can also collect around the heart, prompting the need for a procedure known as pericardiocentesis.

What is Pericardiocentesis?

Not unlike thoracentesis, which removes fluid from around the lungs, pericardiocentesis removes fluid around the heart. However, because the heart is involved, this procedure is much more serious and offers many more complications than the thoracentesis or the paracentesis, which removes fluid from the abdomen.

Also known as a pericardial tap, this is an invasive procedure that is performed by means of a needle and catheter. It can be used to remove fluid to test for the presence of cancer, but in the case of already-diagnosed pleural mesothelioma patients, it is used as a palliative measure to relieve the symptoms the fluid may cause, such as pain and severe shortness of breath.

What to Expect

This procedure is often performed in a cardiac catheterization lab but may be done in a standard operating room as well. It can take anywhere from about 30 to 60 minutes to complete this procedure, depending on the amount of fluid present. A sedative is normally given to relax the patient and an IV will be hooked up to allow for easy administration of fluids or any medications that may be needed during surgery, including in an emergency situation.

A local anesthetic is used to numb the chest area where the needle will be inserted for fluid aspiration. After numbing, the needle and then a catheter will be inserted into the pericardial sac, the membrane around the heart where the fluid has accumulated. Some sort of video or imaging device may be used to insure proper insertion of the needle and to avoid heart damage. Once the fluid has been drained, the catheter with be removed.

The use of more sophisticated imaging has made pericardiocentesis safer than in the past. However, complications can still occur after or during the procedure, including heart attack, cardiac arrest or a heart puncture. After the procedure, patients generally remain in the cath lab for at least two hours so that they may be monitored for any problems. If the procedure is deemed unsuccessful, the doctor may attempt a different procedure.

Once the patient returns home, he will probably be asked to remain off his feet, still, and quiet for at least 24 hours. Patients should be sure to follow all doctor instructions carefully.

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