Pericardial pericardium refers to the procedure in cardiac surgery, which is carried out for pumping out exudate from the near-cardiac region. The accumulating fluid worsens the work of the heart, so the pericardium is released from the effusion.
Puncture is necessary for pericarditis and a number of other diseases that provoke the squeezing of the heart muscle fluid and interfere with its full-fledged work. So, let's talk about the technique of performing pericardial puncture, the indications for the procedure, the kit for it and other features.
To whom it is prescribed
Puncture of the pericardium is shown if necessary to establish the nature of the appearance of exudate. The procedure is carried out by both adults and children. Especially it is required for patients with the threat of a complete stop of blood circulation.
The following video contains useful information with understandable schemes for pericardial puncture:
procedure Dotting is done only if there is
fluid in the pericardium, which needs to be confirmed by a series of studies. The procedure is required to identify the cause of exudation. Often effusion in the pericardium can speak of:
- autoimmune diseases,
- renal failure,
- rheumatoid arthritis,
Carry it out and to identify the prerequisites for the appearance of pericarditis.
Types of diagnostics
Dotting is performed by several methods:
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The opinion of doctors. .. & gt; & gt;
- The Pirogov-Delorme method .The needle is inserted at the level between the fourth and fifth ribs on the left side.
- Procedure for pericardial puncture according to Larrey .The area between the cartilaginous tissue and the xiphoid process on the left side is punctured. The level is between 8-10 ribs.
- Technique of pericardial puncture according to Marfan .In the middle of the region of the xiphoid process( more often under it) a needle is inserted.
The last two types of puncture are considered the most atraumatic. The risks of premature needle displacement, damage to pleural sheets are minimal. And with an accidental puncture of the heart wall, the risks of complications are small, they do not lead to rupture of the myocardium.
Divide the procedure into an emergency and planned. The first type of intervention is required for tamponade of the heart muscle, and the second - with effusion pericardial.
Indications for carrying out
Suitable for 2 main purposes:
- Treatment. Puncture helps to eliminate tamponade and inflammation.
- Diagnostics. It is necessary to establish the cause of pericarditis.
Contraindications for the intervention are as follows:
- aortic dissection,
- limited effusion,
- low platelet count in the blood,
- risk of tamponade after the procedure.
With extreme caution, it is performed with:
- purulent pericarditis,
- metastatic void,
- therapy with anticoagulants,
- haemopericardium post traumatic.
Puncture of the pericardium is a very serious and responsible intervention, as there is a risk of damage not only to the walls of the myocardium, but also to the lungs and stomach. There is a risk of arrhythmia, heart attack and, of course, infection. Therefore, for the procedure, you always need to select an experienced doctor.
The patient undergoes a series of diagnostic procedures designed to accurately determine the presence of exudate in the pericardium.
The cardiosurgeon necessarily charts the future puncture point for the pericardial puncture, and then checks to see if it matches the location of the heart. For this, the thorax is tapped and taped, the patient is sent for an X-ray examination.
How the procedure passes
After a complete diagnosis, the cardiac surgeon marks the exact puncture site, in which there is pulsation, the friction and noise are heard. Next, a suitable punctuation technique is selected.
The patient has a sitting position before puncture. A pillow is put under the waist, and the head leans back. The area of the breast in the puncture area is treated with alcohol and iodine, and 20 minutes before the intervention, an injection of promedola is made. After the end of this stage of preparation before puncture, the patient is administered novocaine 0.5% in the amount of 20 ml.
Needle for puncture is selected thin, as the drug is punctured into the near-cardiac region. At penetration depth is no more than 4 cm. When puncturing, the penetration of the needle is somewhat deeper - 6 cm, and in obese people it enters the depth to 12 cm.
Puncture is performed in the deepest region of the pericardium, which helps to exclude the probability of the needle falling into the thoraciccavity. The procedure is carried out in accordance with the chosen method. The exudate from the cardiac bag is removed by gravity or by a syringe, making it an aspirating motion.
Necessarily, all actions are slow, so that the heart has time to get used to the changing pressure. From the pericardial cavity, up to 400 ml of fluid is withdrawn during puncture. At the end of the procedure, the needle is removed, treating the puncture site, and then gluing it with the glue.
The site in which the procedure will be performed, is anesthetized, so the patient does not feel anything.
You will learn about how the pericardial puncture procedure passes from the following video:
Decoding of the results of pericardial puncture
To prevent injury of the heart, puncture is performed under the control of a cardiac monitor and ultrasound. The sterile electrode is attached to the needle, which makes it possible to observe the operation of the heart muscle continuously. Puncture lasts about 60 minutes.
After it, a number of additional diagnostic studies are designed to exclude the possibility of damage to any organs. The patient is observed by the doctor for a while, measuring breathing, pressure and pulse. The patient himself must comply with bed rest.
The average cost of the procedure
The cost of the puncture depends on the individual characteristics and the clinic. The average price of the procedure is at the level of 15,000.