Pericardiocentesis involves the use of a needle to withdraw fluid from the pericardial sac (membrane that surrounds the heart).

In the past this procedure was performed in a cardiac catheterization laboratory, but now it is usually performed in the procedure room of an intensive care unit, or even at the bedside.

An IV line is inserted in case fluids or medications need to be given. Medication may be given to prevent vasovagal reflex resulting in bradycardia (a slowing of the heartbeat) and hypotension (drop in blood pressure).

The insertion site just below the breastbone (sternum) will be cleansed, and a local anesthetic will be given. A pericardiocentesis needle will then be inserted and guided into the pericardial sac. Electrocardiographic (ECG) leads may be attached by a clip to the needle to help with proper needle positioning. However, echocardiography is more frequently used to help position the needle and monitor drainage.

Once the needle has reached the pericardial sac, a guide wire is inserted. The needle is removed and replaced with a catheter. The fluid is withdrawn through this catheter and put into containers. Usually this pericardial catheter is left in place to continue the draining 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.

If the test is elective, you will 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 feel transient chest pain, which may require pain medication.