Safety Pericardiocentesis with Fluoroscopy Following Cardiac Surgery

Abstract

Purpose: In the treatment of the postsurgical pericardial effusions via pericardiocentesis, determination of the puncture site might be difficult. Contrast echocardiography may not be efficient due to surgical artefacts and pulmonary problems and therefore may lead to inaccurate evaluation. Alternative imaging methods might be helpful to perform the pericardiocentesis with decreased complications. Methods: We retrospectively analyzed the patients who had undergone pericardiocentesis in our department from January 2008 through April 2018. The procedure was performed in slightly semi-seated position with the guidance of the echocardiography and fluoroscopy. Following the catheterization, percutaneous drainage was performed. Results: There were 63 patients needed intervention due to pericardial effusion. 67% of the patients were using warfarin and the next patients were using acetyl salicylic acid and/or clopidogrel. All effusions were in the posterolateral localization. The mean volume of aspirated pericardial fluid was 404 ± 173 mL (150–980 mL). Control echocardiograms showed that almost all fluid was drained in all patients and there were no procedural or follow-up complications. Conclusion: In the treatment of postoperative pericardial effusion, fluoroscopy is an alternative method to locate the catheter accurately in challenging situations following cardiac surgery. Thus, procedural risk minimizes and drainage of pericardial fluid is performed safely.

Left Internal Mammary Artery Transection: A Rare Complication of Pericardiocentesis

“…It is considered a very safe procedure, is usually preceded by echocardiographic visualization, and is performed via the subxiphoid approach. In a study by Ibrahim et al, the incidence of complications seen with fluoroscopic guidance was close to zero [11]. However, this procedure is performed only in the catheterization lab and involves exposing the patient and the physician to significant radiation.…”

High frequency ultrasound‐guided pericardiocentesis performed in the sitting position: A novel apical approach

“…Safe patient positioning involves balancing procedural comfort and optimal procedural setting against the risks related to the patient position 26 . Ibrahim et al reported successful echocardiography and fluoroscopy guided postoperative pericardiocentesis with the patient in slightly semi‐seated position 27 . Mitsuda et al reported successful US‐guided peripherally inserted central catheter (PICC) in a patient with congestive heart failure in the sitting position 28 .…”

“… 26 Ibrahim et al reported successful echocardiography and fluoroscopy guided postoperative pericardiocentesis with the patient in slightly semi‐seated position. 27 Mitsuda et al reported successful US‐guided peripherally inserted central catheter (PICC) in a patient with congestive heart failure in the sitting position. 28 This technique of inserting a drainage in a patient who has assumed the sitting position is simple and feasible.…”

Percutaneous Approach to Pericardial Disease Management

“…Fluoroscopy guided pericardiocentesis is performed in the catheterisation laboratory -most commonly for iatrogenic pericardial effusions that occur during interventional procedures or cardiac surgery [21,22]. Injection of contrast through the needle tip followed by radiographic imaging can be used to assess needle tip position relative to the pericardial space.…”