From the Guidelines
A drain is not always placed after pericardiocentesis, and the decision to do so depends on several clinical factors, including the underlying cause of the effusion, the volume of fluid, and the patient's overall condition. The placement of a pericardial drain is typically considered in emergency situations where pericardiocentesis is performed for cardiac tamponade, as it helps prevent reaccumulation of fluid and allows for monitoring of ongoing drainage 1. However, for diagnostic pericardiocentesis with small effusions or when the fluid is unlikely to reaccumulate, such as in viral or idiopathic pericarditis, the needle may be removed without placing a drain.
When drains are placed, they typically remain for 3-5 days, and surgical pericardial window should be considered if the output drainage is still high 6-7 days after pericardiocentesis 1. The European Society of Cardiology guidelines also recommend pericardial drainage in all patients with large effusions due to the high recurrence rate, and suggest that prevention of recurrences may be achieved by intrapericardial instillation of sclerosing and cytotoxic agents 1. Ultimately, the decision to place a drain after pericardiocentesis rests with the clinician performing the procedure, who must weigh the benefits of continuous drainage against the risks of drain-related complications, such as infection, arrhythmias, or cardiac chamber perforation.
Some key considerations in the decision-making process include:
- The volume and characteristics of the pericardial fluid
- The underlying cause of the effusion
- The patient's overall condition and risk factors for complications
- The likelihood of reaccumulation of the effusion
- The potential benefits and risks of continuous drainage versus removal of the needle without drain placement. In general, the approach to pericardiocentesis and drain placement should be individualized based on the specific clinical scenario and patient factors, with consideration of the latest evidence and guidelines from reputable sources, such as the European Society of Cardiology 1 and the American College of Cardiology 1.
From the Research
Pericardiocentesis and Drain Placement
- Pericardiocentesis is a procedure used to remove pericardial fluid, and it is often performed with catheter insertion and drainage 2.
- The decision to place a drain after pericardiocentesis depends on the underlying cause of the pericardial effusion and the presence of hemodynamic compromise 3.
- In some cases, such as malignant pericardial effusion, pericardiocentesis with catheter drainage and intrapericardial cisplatin instillation may be an effective treatment option 4.
Indications for Drain Placement
- Drain placement is often necessary in cases of large pericardial effusions, cardiac tamponade, or recurrent effusions 2, 3.
- The presence of inflammatory signs, such as fever or pericardial friction rub, may also indicate the need for drain placement 3.
- In cases of purulent pericarditis or neoplastic pericardial effusion, surgical drainage or percutaneous pericardiostomy may be preferred 3.
Techniques for Drain Placement
- Echocardiographically guided pericardiocentesis with contrast agent control is a safe and effective method for pericardial drainage 5.
- The use of a pigtail catheter and a sheath for drainage of pericardial fluid can help to minimize complications 5.
- Interventional radiologists may also perform pericardial drain placement, and the procedure can be done under imaging guidance 6.
Complications and Considerations
- Potential complications of pericardiocentesis and drain placement include catheter blockage, infection, and recurrence of pericardial effusion 2, 5.
- The risk of complications can be minimized by using proper technique, such as echocardiographic guidance, and by removing the drain as soon as possible 5.
- In some cases, repeat procedures or surgical intervention may be necessary to manage recurrent pericardial effusions 3, 5.