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A puncture is a biomaterial sampling by means of a puncture of an organ with a hollow needle. In cardiac surgery, this method is used to puncture the pericardium – a dense membrane around the heart filled with fluid.
The procedure is prescribed for therapeutic purposes and for diagnosis. This is a complex technique that is used only when absolutely necessary.
It gives doctors complete information about the state of the heart and the pericardial region, sometimes even saving the patient’s life. It is better to learn about the features of preparation and possible complications in advance.
Description of the procedure
The human heart is placed in a kind of bag, which is called the pericardium. This dense bag is formed from two layers – inner and outer. The small space between the walls of the heart muscle and the pericardium is filled with fluid. In this part of the body there may be inflammation, purulent processes, mechanical injuries.
A puncture of the pericardium (pericardiocentesis) is done in order to take part of the fluid for analysis. In some cases, for example, with purulent formations or an increase in the amount of fluid, puncture becomes a therapeutic measure.
The technique is quite complicated, the doctor must accurately determine the desired area of uXNUMXbuXNUMXbthe heart and find the points for inserting the needle.
For this, the procedure is carried out under the monitoring of ultrasound or radiography. The technique of carrying out resembles a mini-operation: the patient is first examined, then anesthesia is performed, after the procedure they are left for supervision in the hospital.
But such an operation is tolerated much easier than a strip opening of the chest. A puncture is prescribed in cases of accumulation of blood, air or fluid in the pericardial cavity, heart injuries, pericarditis (for diagnostic purposes).
As a rule, such a manipulation is carried out with cardiac tamponade – squeezing an organ with liquid or air. If there are such indications, excess is pumped out during pericardiocentesis, which improves the patient’s well-being, and in urgent cases, saves life. With pericarditis, a material sampling is needed to determine the cause of the accumulation of exudate or blood.
Preparation of the patient
The puncture is carried out in emergency situations or as planned. Depending on the situation, the patient is prescribed several types of examination.
In urgent cases, the cardiologist decides what tests are needed before the intervention. For the planned procedure appoint:
- echocardiogram;
- chest x-ray;
- blood tests (required for clotting);
- electrocardiogram.
Patients who are undergoing systematic treatment should warn their doctor about all the drugs that are being taken. For 4-6 hours before the procedure, it is forbidden to eat and drink. Be sure to tell the doctor about all the medicines that have been taken over the past XNUMX hours.
Features of
Manipulations are carried out in several ways, such techniques are named after their inventors. The most commonly used technique is Larrey and Marfan, they differ only in the points of entry of the needle. For the patient himself, it practically does not matter what technique will be carried out. Whichever type of pericardiocentesis is prescribed, the operation will be almost the same for the patient.
The patient changes into a sterile hospital gown or exposes the upper body. He occupies a semi-sitting position on the treatment table, sometimes a pillow is placed under his back. Sedatives are injected into the vein, all other manipulations are carried out after 20 minutes. The chest is treated with antiseptic agents.
After determining the entry point, the doctor processes the instrument. The puncture needle is thin and will deliver local anesthetic. First, the anesthetic is injected to anesthetize the skin, then a little deeper, all the way to the pericardium.
The process will take place under the control of fluoroscopy or echocardiography. The doctor will slowly insert the needle, take samples, and withdraw the instrument. To remove air or liquids, a catheter is inserted into the cavity of the needle, through which the excess is brought out.
With pericarditis, they can rinse the cavity and inject an antibiotic with oxygen into it. At the end of the operation, the puncture site is treated with an antiseptic, sometimes sealed with xeol.
The patient then remains under medical supervision for at least 2 hours. If drainage has been installed, the hospital is extended for several days. Biomaterials are sent for analysis, another examination is carried out: a chest x-ray (to make sure the integrity of the organs), checking the pulse and pressure.
Possible complications
During such manipulations, there may be complications. The heart or lungs can be damaged by a puncture instrument, this is considered the most severe consequence of the procedure.
This happens with sudden movements of the patient or the doctor himself during manipulations, insufficient examination also leads to such consequences. The patient in this case receives emergency care immediately, especially difficult situations require urgent surgical intervention.
Also, when inserting a needle, infection is possible if the instruments or the chest have not been treated with an antiseptic.
If the exudate was excreted too quickly, the body is under stress, the heart does not have time to adapt to the changed pressure. This is fraught with disturbed heart rhythm. It is important to monitor your well-being after pericardiocentesis, you need to contact a cardiologist if:
- chills and fever appeared;
- have chest pains that do not go away;
- causeless cough, shortness of breath, difficulty breathing;
- blood is released from the puncture site;
- severe dizziness, nausea;
- there was swelling, redness about the puncture area.
Increases the risk of complications overweight, bad habits, shock of the patient. If the patient has not warned the doctor about the drugs being taken, blood clotting can be reduced, which will lead to serious consequences.
Recovery after a puncture
For some time the patient remains in the hospital for observation. After discharge, the doctor gives recommendations for a speedy recovery. For the first time after pericardiocentesis, it is strictly forbidden to lift weights, overexert yourself, or have sex. Smoking and alcohol are excluded if possible at all, in extreme cases – for 2 weeks.
When discharged from the doctor, you need to consult about what drugs you can take. An anesthetic will be prescribed, you need to drink it in a clearly indicated dosage. At the first sign of complications, you should consult a doctor or call an ambulance.
For quick rehabilitation, a healthy diet is recommended, as a rule, diet No. 15 is prescribed. Periodically you need to go for leisurely walks, breathe fresh air. In winter, be sure to dress warmly; in summer, avoid overheating and sunbathing on the beach. Stressful situations are especially undesirable for heart disease, they should be avoided as much as possible. For particularly sensitive patients, a cardiologist may recommend sedatives. You can return to an active lifestyle after the approval of your doctor.
Important questions
Such cardiac surgery is carried out in public hospitals and hospitals. You can also go through it in cardiology clinics and medical centers in the private segment. To choose between medical facilities, you can look for reviews on the websites of private clinics. Feedback about doctors and public hospitals is on city forums.
When choosing, it should be borne in mind that the private segment is better equipped, the service here adapts as much as possible to the client. In public institutions, both equipment and service are “lame”. But the price difference for such a service is quite large.
In public hospitals and hospitals, pericardiocentesis will cost $130-$170, excluding anesthesia and additional medications. In a private clinic, the price for such a procedure will be from 250 to 500 dollars, in rare cases it can be higher. The final cost depends on the condition of the patient and the range of actions of the doctor.
The puncture is at least unpleasant. To reduce pain, anesthesia is given before the movement of the needle, but pain is felt during the puncture. There will be no catastrophic sensations, the procedure is unpleasant, but quite tolerable. Before the operation, you should calm down, think about what is necessary for a full life, and possibly for salvation.