Overview of Optimal Techniques for Pericardiocentesis in Contemporary Practice

Abstract

Purpose of Review

This review summarizes the optimal techniques for the performance of pericardiocentesis in contemporary practice, highlighting the indications, contraindications, and techniques used. Routine pericardial catheter management and the diagnostic role of pericardial fluid analysis are described.

Recent Findings

Echocardiographic-guided pericardiocentesis should be considered the therapy of choice in current clinical practice and may be performed safely despite the presence of coagulopathy and thrombocytopenia in the hands of expert operators. Computed tomography (CT)-guided techniques may provide a useful adjunctive tool in patients with poor acoustic windows or complex loculated effusions. Conservative management utilizing pericardiocentesis may be considered in select patients with device lead and interventional-related pericardial effusions.

Summary

Echocardiographic-guided pericardiocentesis with extended pericardial drainage (goal output < 50 mL/24 h) should be considered the standard of care in contemporary practice. Pericardial fluid analysis should be tailored based on the clinical history and appearances of the pericardial fluid.

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Correspondence to Sushil Allen Luis.

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Sushil Allen Luis reports being on the advisory board for Kiniksa Pharmaceuticals, and being a consultant and being on the advisory board for SOBI Pharmaceuticals.

Garvan C. Kane, Chris R. Luis, Jae K. Oh, and Lawrence J. Sinak declare that they have no conflict of interest.

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Luis, S.A., Kane, G.C., Luis, C.R. et al. Overview of Optimal Techniques for Pericardiocentesis in Contemporary Practice. Curr Cardiol Rep 22, 60 (2020). https://doi.org/10.1007/s11886-020-01324-y

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Keywords

  • Pericardiocentesis
  • Echocardiography-guided pericardiocentesis
  • Cardiac tamponade
  • Pericardial effusion
  • Pericardial fluid analysis