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Pericardiocentesis is a minimally invasive procedure that drains fluid buildup in the pericardium, or lining around the heart. Pericardiocentesis uses a needle to drain fluid, which eases pressure on the heart. It may be used to treat symptoms of pleural and pericardial mesothelioma.

01. Overview of Pericardiocentesis

What Is Pericardiocentesis?

Pericardiocentesis is a minimally invasive medical procedure that drains excess fluid from the pericardium, a thin sac around the heart. This procedure is often used to treat swelling within the pericardium, called pericardial effusion.

Pericardial effusion can be a symptom of diseases affecting the heart and surrounding tissues, such as pericardial mesothelioma. In a healthy person, the pericardium has a small amount of fluid but plenty of room for the heart to beat normally. In a person with pericardial effusion, additional fluid collects in the pericardium and puts pressure on the heart. Pericardiocentesis uses a needle to drain some of this fluid, allowing the heart to beat more normally.

A pericardiocentesis procedure may be used in an emergency scenario to reduce pressure on the heart. But it is also used in non-critical scenarios too, such as relieving shortness of breath or chest pain from pericardial effusion.

Doctors can identify pericardial effusion by conducting tests like a chest X-ray or echocardiogram. An echocardiogram is an ultrasound of the heart, which can show the amount of fluid buildup in the pericardium. Echocardiography may also help determine if there is decreased heart function because of cardiac tamponade.

When Do Patients Need a Pericardiocentesis?

Pericardial Effusion

Pericardial effusion occurs when an abnormal amount of fluid builds up in the pericardium. This can be caused by many things, including injuries, infections, pericardial mesothelioma and metastasis of other cancers.

Cardiac Tamponade

Cardiac tamponade occurs when the severity of pericardial effusion escalates. Fluid and pressure build up so much that the heart struggles to function normally, and blood pressure drops, despite an increase in heart rate. Also known as pericardial tamponade, it can be caused by cancer, infections, injuries and some diseases.

Common causes of pericardial effusion and cardiac tamponade include:

  • Advanced cancer
  • Autoimmune diseases
  • Heart attacks
  • Heart cancer
  • Heart failure
  • Hypothyroidism
  • Inflammation or infection of the pericardium
  • Kidney failure
  • Pericardial mesothelioma
  • Tuberculosis

A pericardiocentesis procedure may be used as part of a multimodal treatment plan for a variety of conditions, including pericardial mesothelioma.

How Does Pericardiocentesis Treat Pericardial Mesothelioma Symptoms?

Pericardial effusion is a common symptom of pericardial mesothelioma. It may also present in patients with cancers that have metastasized outside of the original location.

An oncologist may recommend pericardiocentesis for malignant mesothelioma patients to ease some symptoms. This may include shortness of breath, chest pain, swelling and increased heart rate. Some mesothelioma symptoms, like difficulty breathing, may improve for some patients during or right after the treatment.

Pericardiocentesis cannot cure mesothelioma, but it may help alleviate symptoms. The procedure has an extremely high success rate at removing fluid from around the heart. In a multi-center study, doctors reported a 99% success rate. While side effects from the procedure are possible, the life-saving potential of pericardiocentesis generally outweighs the risk.

While pericardiocentesis may be used as an emergency treatment, it can also be a part of palliative care. By relieving pain and pressure around the heart, the treatment can make patients more comfortable.

02. What to Expect

What to Expect When Undergoing a Mesothelioma Pericardiocentesis Procedure

Pericardiocentesis is a minimally invasive procedure. A patient’s doctor or care team member can explain the exact process and details of their treatment. Generally, doctors follow these steps for a pericardiocentesis procedure to remove fluid from around the heart:

  1. Conduct an ultrasound to find the best placement for the needle.
  2. Numb the area where the needle will go.
  3. Insert the needle far enough to reach the pericardium. The needle does not go into the heart. For larger volumes of fluid, a healthcare provider may place a tube to help it drain, also called a catheter.
  4. Drain the built-up fluid from the pericardium.
  5. Remove the needle or catheter once draining is complete.
  6. Clean and bandage the insertion site.

A doctor may perform an emergency pericardiocentesis procedure differently. A patient’s mesothelioma doctor can answer any questions about the procedure to help them prepare and know what to expect.

How to Prepare for Pericardiocentesis

When patients know they are going to have pericardiocentesis, there are a few things they can do to prepare. The medical team also provides specific instructions for patients to follow.

Experts say patients should stop eating about eight hours before the procedure. There may be some allowance for clear liquids. Patients should confirm their fasting needs with their doctors.

At the start of the appointment, a healthcare provider will set up an intravenous (IV) line to administer medications. They will then prepare the injection site for the needle. This may include removing hair from the area and cleaning and disinfecting the skin. Doctors may use multiple needles to drain the fluid, so they may prepare multiple insertion sites.

Doctors may also set up monitoring devices for the duration of the pericardiocentesis procedure. This includes sensors to measure blood pressure, breathing, heart rate and blood oxygen. It may also involve attaching electrodes for an electrocardiogram (ECG or EKG) to monitor electrical signals in the heart.

Patients should review details of the procedure beforehand with their doctor.

They should also confirm if pericardiocentesis and any related procedures are covered by their insurance. Like all medical procedures, different insurance plans and providers offer varying levels of coverage. A cancer center or medical provider may be able to help patients learn more about their coverage for specific procedures.

Does Insurance Cover Pericardiocentesis Treatment Costs for Pericardial Effusion?

Patients should contact their insurance provider before any treatments or procedures to find out if the cost of the treatment is covered. Qualified procedures will vary from plan to plan.

Patients may find their pericardiocentesis procedure is covered in full, or they may have to pay portions out-of-pocket. Financial assistance can help cover out-of-pocket treatment costs for mesothelioma patients. Grants or legal compensation may help patients cover these costs.

03. After a Pericardiocentesis Procedure

What to Expect After a Mesothelioma Pericardiocentesis Procedure

Every patient will have a unique experience with pericardiocentesis, depending on their illness and specific needs. Their care team can let them know what to expect during and after the procedure.

Providers usually do another ultrasound after the procedure is finished to confirm they removed enough fluid. In some cases, they may send the drained fluid for more testing. However, some reports suggest this fluid has a low detection rate for pericardial mesothelioma.

Recovery from pericardiocentesis depends on a variety of factors but may be swift. For mesothelioma patients, cancer stage, additional health concerns and a patient’s unique circumstances can all impact pericardiocentesis recovery time.

Recovery From Pericardiocentesis

Recovery from pericardiocentesis may go quickly for some patients. However, recovery will vary depending on a patient’s individual circumstances and needs. A doctor can help explain what to expect and patients should stay in touch with their care team for any questions or concerns.

What if Patients Have Recurrent Pericardial Effusions?

Some patients may experience recurrent pericardial effusions. This occurs when fluid buildup returns after pericardiocentesis. If recurrence happens, a patient may be eligible for a pericardiectomy to prevent future fluid buildup.

A pericardiectomy, or pericardial stripping, is a surgical procedure to remove some or all of the pericardium. Removing it may help patients who have had multiple occurrences of pericardial effusions.

04. Benefits

Benefits of Pericardiocentesis for Mesothelioma

Pericardiocentesis can be a valuable treatment for patients with mesothelioma. Benefits of pericardiocentesis for mesothelioma include:

  • Ease of procedure: Pericardiocentesis is much less invasive than other common mesothelioma surgeries. It can also be performed quickly and typically involves uncomplicated prep and recovery.
  • Relief of symptoms: The pericardiocentesis procedure can help treat some symptoms associated with pericardial effusion and pericardial mesothelioma, like pain and shortness of breath. Some mesothelioma patients may experience relief from symptoms of pericardial effusion as quickly as partway through the pericardiocentesis procedure.
  • Understanding of causes: This procedure can also help doctors understand what caused the fluid buildup. For pericardial mesothelioma, this is usually directly connected to the tumors in the pericardium. In patients with other types of mesothelioma, pericardial effusion may be a result of metastasized tumors.

Pericardiocentesis is a simple procedure that may provide fast relief for patients with relatively easy preparation and recovery. It can also give doctors additional information about the cause of pericardial effusion.

05. Side Effects & Risks

Pericardiocentesis Side Effects and Risks

Pericardiocentesis is a relatively safe medical procedure. Doctors can reduce risks by using imaging assistance, like ultrasounds or fluoroscopy, to guide needle placement.

Potential Complications of a Mesothelioma Pericardiocentesis

  • Air in the chest cavity
  • Damage to surrounding tissues, like major blood vessels, the heart, liver, lungs, pericardium and stomach
  • Excess bleeding
  • Infection or sepsis

Patients should still consult with their care team to learn of any side effects they should look out for. It’s also important for patients to let their doctor or care team know of any side effects they experience after the procedure.

06. Common Questions

Common Questions About Mesothelioma Pericardiocentesis

How much fluid is removed in pericardiocentesis?

In emergency situations, pericardiocentesis may remove 100 mL to 150 mL of fluid. In cases where the fluid builds up over time, pericardiocentesis may remove up to 2 liters of fluid.

What is the success rate of pericardiocentesis?

Pericardiocentesis has a high rate of success for patients with pericardial effusion, or fluid buildup around the heart. In a multi-center study, doctors reported a 99% success rate for pericardiocentesis procedures.

Which complications are most likely with pericardiocentesis?

A multi-center study found pulmonary edema and vasovagal reactions were the most common pericardiocentesis complications. Pulmonary edema is fluid collecting in the lungs. Vasovagal responses are sudden drops in heart rate and blood pressure. There is also a risk of damage to surrounding tissues during the procedure.