Understanding Pericardial Effusion and Management

Pericardial effusion is a condition where fluid builds up around the heart, which, if left unchecked, can lead to some pretty serious complications like cardiac tamponade. In this video, we're going to talk about the causes of pericardial effusion, how to identify it, and some key steps in managing it to keep our patients safe. All right, I welcome you guys back to another video lesson from ICU Advantage. For those of you who don't know me, my name is Eddie Watson, and my goal with this channel here is to try to give you guys the confidence to succeed in the ICU by taking these complex critical care subjects and making them easy to understand. I truly hope that I'm able to do just that. If I am, I do invite you to subscribe to the channel below. Make sure you hit that bell icon, that way you never miss out when I release a new lesson. Now also, if you do enjoy these lessons and you'd be interested in getting CE credits for following along with them, then head on over to icuadvantage.com forward slash academy and join the ICU Advantage Academy where you can watch all these videos. You'll have access to all the notes, including the new notes that I'm currently working on updating, as well as audio-only versions of these lessons. And most importantly, you'll be able to actually earn CE credits for participating in this education. So I've got some great deals going on over there, so make sure and check that out. Now, if you would like to support the channel, but really don't have a need for the CEs, or if you just want access to things like the notes, then you might also want to take a look at either the YouTube or Patreon memberships. Again, links to both of those. All that stuff is going to be down in the description below. In its most basic definition, a pericardial fusion is a collection of fluid around the heart in the pericardial sac that surrounds it. Now we normally have fluid in there, which I'll talk about in a minute here, but if the volume of fluid increases, there are some potentially serious consequences that can result for our patient. So to start things off and really understand about pericardial effusion, we need to talk about the anatomy of the heart and some of the physiology that's at play with our pericardial effusion. So here we have our heart. The heart itself though doesn't just sit in the chest. It's surrounded by the pericardial sac, which helps to protect the heart. The pericardial sac is actually composed of two layers. The first layer is the visceral pericardium, which is a thin single layer of cells that adhere to the epicardium or the outermost layer of the heart. This layer provides a smooth surface for the heart to move around as it beats. Then we have a thick fibrous parietal pericardium, which is composed of collagen and elastin, and this outer layer adheres to the mediastinal structures that are surrounding the heart, like the lungs, diaphragm, sternum, great vessels, etc. This layer provides another smooth surface on the inside to allow the heart to easily move around. Being the thick fibrous layer, it also helps to protect the heart. Now in between these two layers, we have what we call the pericardial space. that is filled with serous fluid. Normally we have about 15 to 50 mLs of the fluid in there. The serous fluid here provides some cushioning for the heart and really helps to lubricate the movement of the heart. All right, so that was the pertinent anatomy here. Let's talk about the pathophysiology of our pericardial effusion. So a pericardial effusion is caused by either an acute or chronic accumulation of fluid in this pericardial sac. Now this fluid accumulation can either be transidative or exudative when we're referring to the composition of and the underlying mechanism of the fluid buildup. So first let's talk about our transidative. So transidative effusions are typically going to be caused by either an increased hydrostatic pressure or decreased oncotic pressure. Both can lead to fluid moving into the pericardial sac. Now this fluid is typically going to be clear or straw colored, and the fluid often has lower protein levels than what we would find in serum. Now some transidative causes could be things like congestive heart failure, and this can lead to increased venous pressure, increasing hydrostatic pressure, liver cirrhosis, which can lead to low albumin, and thus low oncotic pressure and fluid seepage into the space. Also hypoalbuminemia, which is often going to be related to malnutrition or nephrotic syndrome, can also lead to this low oncotic pressure. Or even kidney failure can lead both to uremia and uremic pericarditis. Now on the flip side, exudative effusions are typically caused by inflammatory or infectious processes, but they can also be the result of bleeding. With our inflammatory and infectious causes, capillary permeability is going to be increased, allowing fluid and proteins to enter this pericardial sac. Now this fluid is often going to be cloudy with high protein levels, and it can contain cells like bacteria as well as other inflammatory markers. Now some causes here for our exudative infusions could be infectious, so bacterial and viral are going to be the most common here, but we can also see fungal and parasitic, inflammatory disease, and this can include pericarditis, as well as other autoimmune diseases like rheumatoid arthritis, lupus, or other connective tissue disorders. This can be the result of primary or metastatic cancers. as well as post-MI, which can also lead to an inflammatory process called Dressler syndrome. Surprisingly, hydralazine can also lead to a rare drug interaction called HILS or hydralazine-induced lupus syndrome. And then along with all of that, bleeding into the pericardial sac can lead to a sanguineous fluid accumulating in this pericardial sac. This is usually going to be the result of either chest trauma, thoracic surgery, or or some iatrogenic procedure such as coronary artery perforation and cath lab, pacemaker insertion, or even central line placement. We can also see this result from anticoagulation, or even from an aortic dissection. Alright, now given the various causes of fluid accumulation, the end result is that we have excessive fluid in this pericardial sac. The pericardial sac is generally not very elastic. But if a slow effusion develops, over time we can see it actually stretch, and a pretty large volume of fusion can develop over time. Now as this fluid accumulates in the pericardial sac, it's going to increase the intrapericardial pressure on the heart. The increased pressure, if high enough, can lead to compression of the heart, most notably the thinner walled right ventricle. This compression of the right ventricle leads to venous congestion, and then decreased forward flow, thus decreased filling of the left ventricle, and ultimately decreased stroke volume. Now initially the body will compensate for this by increasing heart rate and contractility to make up for this lost stroke volume, but if severe enough, the effusion and this pressure can lead to decreased cardiac output and blood pressure. Now for our slowly developing pericardial effusions, it may take 2 to 300 ml of fluid before symptoms even present, and sometimes these can grow to 1 to 2 liters of fluid. For acute and rapidly developing effusions, sometimes even 50 to 100 ml can cause symptoms and even lead to hemodynamic compromise. Alright, so now that we've discussed what an effusion is, some of the causes behind it, as well as some of the problems that can result from it, Let's talk about some of the signs and symptoms that we'd expect to see, as well as how we're going to diagnose it. So our signs and symptoms will vary based on the size of the effusion, the speed of accumulation, and really the underlying cause. As the effusion grows larger or is rapidly developing, the signs and symptoms are going to tend to worsen. The most common symptoms are going to be dyspnea and chest discomfort. There are some Other symptoms, though, we can see orthopnea, which is going to be difficulty breathing when they're lying down, and this may be relieved by them sitting up. They can also have a cough, although it's often going to be a dry cough, and this is going to be the result of compression of nearby lung structures. The patient may also have hoarseness and or dysphagia, and this can result from compression of the laryngeal nerve and or the esophagus by an enlarged pericardium. The patient may be exhibiting fatigue and weakness, and this is going to be a result of that decreased cardiac output, as well as lightheadedness and syncope, again, as a result of that cardiac output. And then edema, if the impact of the cardiac output has taken place over time, we can see peripheral edema develop, especially in the legs. Now, some signs that we would see on physical exam would include muffled or distant heart tones, electrical alternans on EKG. as well as pulseless paradoxus, where we would see the patient's blood pressure drop on inhalation. Now as things progress further, we can see the patient develop severe hemodynamic compromise and can lead to cardiac arrest. This is something that we call cardiac tamponade. which I am doing a separate lesson, which is going to be the next lesson after this one, specifically on this topic. All right, so how is it that we actually diagnose a pericardial effusion? Well, the gold standard is going to be with echocardiography or echo, as it allows us to not only see the size, but also any impact on cardiac function and surrounding vessels and structures. Now, we can also identify them on CT or MRI. although they are going to be less informative than an echo. A chest x-ray may also help to diagnose a pericardial fusion, especially a large one, by showing us an enlarged cardiac silhouette. And then finally, as I just mentioned on EKG, we can also see electrical ultramans and low voltage, and these can serve as cues to this diagnosis. Okay, so now your patient's been diagnosed with having a pericardial fusion. let's actually talk about some key points for our management and treatment of these patients. So our decisions on management are going to depend on the volume of fluid, the rate of the accumulation, the underlying cause, as well as the symptoms that the patient is presenting with, and most importantly, if cardiac teoponade is present. Some effusions don't require us to do anything and to simply observe them and the patient. Some examples of this would be If the effusion is small, so only a few millimeters thick on echo, and the patient is having no symptoms, if there are no signs of progression of the effusion, oftentimes these small effusions will resolve on their own. If the fluid accumulation in the pericardial space is slow, then we can allow for the pericardium to stretch over time, which reduces the risk for more serious complications, including cardiac tamponade. In these cases, the patients are going to be monitored with serial echoes, as well as evaluating their symptoms to detect and monitor for any changes in size of this effusion. As long as the patient remains without symptoms, we may just monitor for some time. If the patient is asymptomatic and there's no hemodynamic compromise, so hypotension, tachycardia, pulseless paradoxes, then simply observing and not intervening may be appropriate. And then finally, if the asymptomatic patient or mildly symptomatic patient has a cause of the pericardial effusion that is identifiable and treatable, then simply managing the underlying cause may be enough in order to reduce the effusion. Close monitoring will be necessary, especially in cases with autoimmune causes, as the size of the effusion can actually change rapidly with the disease activity. That said, there are times when we would need to intervene directly to reduce or eliminate the pericardial effusion. So first and foremost is gonna be if the effusion is causing or progressing towards cardiac tamponade. Again, the next lesson is gonna be dedicated to this, but this is a life-threatening situation and requires immediate intervention. For now though, a few things to be on the lookout for are gonna be hypotension and shock resulting from reduced cardiac output, distended jugular veins, due to impaired venous return. This backup of blood results from the lack of forward progress due to the reduced cardiac output. And then muffled distant heart sounds on auscultation. For these patients, immediate drainage of the effusion is a matter of life and death. Next, for our symptomatic patients, especially those with severe chest pain, dyspnea, or orthopnea due to the size of the effusion, that we would want to drain the effusion to improve quality of life. If they have symptoms that don't resolve or even get worse with conservative treatment and management, then this is when we want to consider draining it. If a patient has a large or rapidly progressing pericardial effusion, they are more likely to progress towards cardiac tamponade. So if the echo is showing a large effusion or one that's rapidly growing in size, then we will need to drain the effusion to prevent this hemodynamic compromise and collapse. Now, some patients can have pericardial effusions that persist or reoccur despite the appropriate treatment of the underlying cause. In these cases, we may need to consider draining the effusion as well as considering an option that would provide continuous drainage, such as a pericardial drain or a pericardial window. And then finally, for patients with malignant pericardial effusion, their exudative effusion, which is caused by the cancer. is often going to reoccur and may be symptomatic. In these cases, palliative drainage may help to improve symptoms for them and quality of life, but just as with the other recurring or persistent effusions, The drainage here, we're going to want a longer-term solution that's probably going to be needed. Again, a pericardial drain or pericardial window. All right, and then lastly, let's just review over the methods to drain the effusion. So I just hit on all of these as I went through the previous list here, but I do want to concisely group them together so that we can quickly talk about the different ways in which we can drain the pericardial effusion. So the primary way to do so is with a pericardiocentesis. So this involves the insertion of a needle into the pericardial sac and then draining fluid this way, as well as collecting a sample for testing if it's needed. The goal is to remove the fluid and volume from the pericardial space and restore hemodynamic stability and to reduce or eliminate any symptoms for the patient. So this is going to require the guidance of an echo to ensure the proper placement of the needle without causing damage to the heart itself. This is typically done with a local anesthetic, and their approach is either subxiphoid, parasternal, or apical, really depending on the location and position of the effusion. Now once the needle is in the pericardial sac, a catheter can actually be inserted and advanced in order to continue draining the fluid. Now on this subject, oftentimes once this fluid is drained, this catheter is removed. But in some cases, especially for cases where there's concern for redevelopment of the effusion, that this catheter can be left in place, and then the patient may remain with a pericardial drain. So this is going to allow for us to fully drain and prevent reaccumulation of fluid in this pericardial space, and this is also helpful in pericardial effusions that result from pericarditis. Fully draining this purulent fluid can help to prevent loculated pockets that can really complicate treatment. Now with this drain in place, we can closely monitor the amount. characteristics and consistency of the draining fluid. This combined with regular imaging can help to guide the decision for how long to leave this drain in place. That said, the pericardiocentesis and the subsequent placement of a drain is certainly not without risk, both in terms of damage to the heart and the surrounding structures, as well as infection, especially with the drains. Now, surgical management of the effusion may be required for some very different reasons here. First, if the fusion is a result of bleeding, so whether it's one of those iatrogenic causes, surgery, trauma, this is oftentimes going to require surgical intervention to fix and stop the bleeding. In these cases, post-op, we're actually going to have another type of drain in place that we call mediastinal chest tubes, which are going to be connected to a typical chest tube drainage system. Now also, as previously mentioned, another surgical intervention that we can do is a pericardial window. And this is actually a minimally invasive surgery that creates a small hole or window in the pericardium to allow the fluid to drain into the pleural cavity. And then a pleural chest tube may be placed in order to help drain the fluid from the pleural space. All right, that about covers the different aspects of pericardial effusion. Hopefully you now have a better understanding of what a pericardial effusion is, as well as the anatomy and pathophysiology. the effusion and how they can cause symptoms in our patients as well as serious risks that come along with them and finally you should have a better understanding of when and how we intervene to treat these patients including the different ways we might do so so I hope that you guys found this information useful if you did please leave me a like on the video down below it really helps YouTube know to show this video to other people out there as well as leave me a comment down below I love reading the comments that you guys leave and I try to respond to as many people as I can Make sure you subscribe to this channel if you haven't already, and a special shout out to the awesome YouTube and Patreon members out there. The support that you're willing to show me and this channel is truly appreciated, so thank you guys so very much. If you'd be interested in showing additional support for this channel, you can find links to both the YouTube and Patreon membership down below. Head on over there and check out some of the perks that you guys get for doing just that, as well as check out some of the links to other nursing gear, as well as some awesome t-shirt designs I have down there as well. Make sure you guys stay tuned for the next lesson that I release. Otherwise, in the meantime, here's a couple awesome lessons I'm going to link to right here. As always, thank you guys so much for watching. Have a great day.

For those of you who don't know me, my name is Eddie Watson, and my goal with this channel here is to try to give you guys the confidence to succeed in the ICU by taking these complex critical care subjects and making them easy to understand. I truly hope that I'm able to do just that. If I am, I do invite you to subscribe to the channel below.

Make sure you hit that bell icon, that way you never miss out when I release a new lesson. Now also, if you do enjoy these lessons and you'd be interested in getting CE credits for following along with them, then head on over to icuadvantage.com forward slash academy and join the ICU Advantage Academy where you can watch all these videos. You'll have access to all the notes, including the new notes that I'm currently working on updating, as well as audio-only versions of these lessons.

And most importantly, you'll be able to actually earn CE credits for participating in this education. So I've got some great deals going on over there, so make sure and check that out. Now, if you would like to support the channel, but really don't have a need for the CEs, or if you just want access to things like the notes, then you might also want to take a look at either the YouTube or Patreon memberships.

Again, links to both of those. All that stuff is going to be down in the description below. In its most basic definition, a pericardial fusion is a collection of fluid around the heart in the pericardial sac that surrounds it.

Now we normally have fluid in there, which I'll talk about in a minute here, but if the volume of fluid increases, there are some potentially serious consequences that can result for our patient. So to start things off and really understand about pericardial effusion, we need to talk about the anatomy of the heart and some of the physiology that's at play with our pericardial effusion. So here we have our heart.

The heart itself though doesn't just sit in the chest. It's surrounded by the pericardial sac, which helps to protect the heart. The pericardial sac is actually composed of two layers.

The first layer is the visceral pericardium, which is a thin single layer of cells that adhere to the epicardium or the outermost layer of the heart. This layer provides a smooth surface for the heart to move around as it beats. Then we have a thick fibrous parietal pericardium, which is composed of collagen and elastin, and this outer layer adheres to the mediastinal structures that are surrounding the heart, like the lungs, diaphragm, sternum, great vessels, etc.

This layer provides another smooth surface on the inside to allow the heart to easily move around. Being the thick fibrous layer, it also helps to protect the heart. Now in between these two layers, we have what we call the pericardial space.

that is filled with serous fluid. Normally we have about 15 to 50 mLs of the fluid in there. The serous fluid here provides some cushioning for the heart and really helps to lubricate the movement of the heart.

All right, so that was the pertinent anatomy here. Let's talk about the pathophysiology of our pericardial effusion. So a pericardial effusion is caused by either an acute or chronic accumulation of fluid in this pericardial sac. Now this fluid accumulation can either be transidative or exudative when we're referring to the composition of and the underlying mechanism of the fluid buildup.

So first let's talk about our transidative. So transidative effusions are typically going to be caused by either an increased hydrostatic pressure or decreased oncotic pressure. Both can lead to fluid moving into the pericardial sac.

Now this fluid is typically going to be clear or straw colored, and the fluid often has lower protein levels than what we would find in serum. Now some transidative causes could be things like congestive heart failure, and this can lead to increased venous pressure, increasing hydrostatic pressure, liver cirrhosis, which can lead to low albumin, and thus low oncotic pressure and fluid seepage into the space. Also hypoalbuminemia, which is often going to be related to malnutrition or nephrotic syndrome, can also lead to this low oncotic pressure. Or even kidney failure can lead both to uremia and uremic pericarditis. Now on the flip side, exudative effusions are typically caused by inflammatory or infectious processes, but they can also be the result of bleeding.

With our inflammatory and infectious causes, capillary permeability is going to be increased, allowing fluid and proteins to enter this pericardial sac. Now this fluid is often going to be cloudy with high protein levels, and it can contain cells like bacteria as well as other inflammatory markers. Now some causes here for our exudative infusions could be infectious, so bacterial and viral are going to be the most common here, but we can also see fungal and parasitic, inflammatory disease, and this can include pericarditis, as well as other autoimmune diseases like rheumatoid arthritis, lupus, or other connective tissue disorders.

This can be the result of primary or metastatic cancers. as well as post-MI, which can also lead to an inflammatory process called Dressler syndrome. Surprisingly, hydralazine can also lead to a rare drug interaction called HILS or hydralazine-induced lupus syndrome.

And then along with all of that, bleeding into the pericardial sac can lead to a sanguineous fluid accumulating in this pericardial sac. This is usually going to be the result of either chest trauma, thoracic surgery, or or some iatrogenic procedure such as coronary artery perforation and cath lab, pacemaker insertion, or even central line placement. We can also see this result from anticoagulation, or even from an aortic dissection. Alright, now given the various causes of fluid accumulation, the end result is that we have excessive fluid in this pericardial sac. The pericardial sac is generally not very elastic.

But if a slow effusion develops, over time we can see it actually stretch, and a pretty large volume of fusion can develop over time. Now as this fluid accumulates in the pericardial sac, it's going to increase the intrapericardial pressure on the heart. The increased pressure, if high enough, can lead to compression of the heart, most notably the thinner walled right ventricle. This compression of the right ventricle leads to venous congestion, and then decreased forward flow, thus decreased filling of the left ventricle, and ultimately decreased stroke volume. Now initially the body will compensate for this by increasing heart rate and contractility to make up for this lost stroke volume, but if severe enough, the effusion and this pressure can lead to decreased cardiac output and blood pressure.

Now for our slowly developing pericardial effusions, it may take 2 to 300 ml of fluid before symptoms even present, and sometimes these can grow to 1 to 2 liters of fluid. For acute and rapidly developing effusions, sometimes even 50 to 100 ml can cause symptoms and even lead to hemodynamic compromise. Alright, so now that we've discussed what an effusion is, some of the causes behind it, as well as some of the problems that can result from it, Let's talk about some of the signs and symptoms that we'd expect to see, as well as how we're going to diagnose it. So our signs and symptoms will vary based on the size of the effusion, the speed of accumulation, and really the underlying cause.

As the effusion grows larger or is rapidly developing, the signs and symptoms are going to tend to worsen. The most common symptoms are going to be dyspnea and chest discomfort. There are some Other symptoms, though, we can see orthopnea, which is going to be difficulty breathing when they're lying down, and this may be relieved by them sitting up. They can also have a cough, although it's often going to be a dry cough, and this is going to be the result of compression of nearby lung structures. The patient may also have hoarseness and or dysphagia, and this can result from compression of the laryngeal nerve and or the esophagus by an enlarged pericardium.

The patient may be exhibiting fatigue and weakness, and this is going to be a result of that decreased cardiac output, as well as lightheadedness and syncope, again, as a result of that cardiac output. And then edema, if the impact of the cardiac output has taken place over time, we can see peripheral edema develop, especially in the legs. Now, some signs that we would see on physical exam would include muffled or distant heart tones, electrical alternans on EKG.

as well as pulseless paradoxus, where we would see the patient's blood pressure drop on inhalation. Now as things progress further, we can see the patient develop severe hemodynamic compromise and can lead to cardiac arrest. This is something that we call cardiac tamponade. which I am doing a separate lesson, which is going to be the next lesson after this one, specifically on this topic. All right, so how is it that we actually diagnose a pericardial effusion?

Well, the gold standard is going to be with echocardiography or echo, as it allows us to not only see the size, but also any impact on cardiac function and surrounding vessels and structures. Now, we can also identify them on CT or MRI. although they are going to be less informative than an echo. A chest x-ray may also help to diagnose a pericardial fusion, especially a large one, by showing us an enlarged cardiac silhouette. And then finally, as I just mentioned on EKG, we can also see electrical ultramans and low voltage, and these can serve as cues to this diagnosis.

Okay, so now your patient's been diagnosed with having a pericardial fusion. let's actually talk about some key points for our management and treatment of these patients. So our decisions on management are going to depend on the volume of fluid, the rate of the accumulation, the underlying cause, as well as the symptoms that the patient is presenting with, and most importantly, if cardiac teoponade is present.

Some effusions don't require us to do anything and to simply observe them and the patient. Some examples of this would be If the effusion is small, so only a few millimeters thick on echo, and the patient is having no symptoms, if there are no signs of progression of the effusion, oftentimes these small effusions will resolve on their own. If the fluid accumulation in the pericardial space is slow, then we can allow for the pericardium to stretch over time, which reduces the risk for more serious complications, including cardiac tamponade.

In these cases, the patients are going to be monitored with serial echoes, as well as evaluating their symptoms to detect and monitor for any changes in size of this effusion. As long as the patient remains without symptoms, we may just monitor for some time. If the patient is asymptomatic and there's no hemodynamic compromise, so hypotension, tachycardia, pulseless paradoxes, then simply observing and not intervening may be appropriate.

And then finally, if the asymptomatic patient or mildly symptomatic patient has a cause of the pericardial effusion that is identifiable and treatable, then simply managing the underlying cause may be enough in order to reduce the effusion. Close monitoring will be necessary, especially in cases with autoimmune causes, as the size of the effusion can actually change rapidly with the disease activity. That said, there are times when we would need to intervene directly to reduce or eliminate the pericardial effusion. So first and foremost is gonna be if the effusion is causing or progressing towards cardiac tamponade.

Again, the next lesson is gonna be dedicated to this, but this is a life-threatening situation and requires immediate intervention. For now though, a few things to be on the lookout for are gonna be hypotension and shock resulting from reduced cardiac output, distended jugular veins, due to impaired venous return. This backup of blood results from the lack of forward progress due to the reduced cardiac output. And then muffled distant heart sounds on auscultation. For these patients, immediate drainage of the effusion is a matter of life and death.

Next, for our symptomatic patients, especially those with severe chest pain, dyspnea, or orthopnea due to the size of the effusion, that we would want to drain the effusion to improve quality of life. If they have symptoms that don't resolve or even get worse with conservative treatment and management, then this is when we want to consider draining it. If a patient has a large or rapidly progressing pericardial effusion, they are more likely to progress towards cardiac tamponade. So if the echo is showing a large effusion or one that's rapidly growing in size, then we will need to drain the effusion to prevent this hemodynamic compromise and collapse.

Now, some patients can have pericardial effusions that persist or reoccur despite the appropriate treatment of the underlying cause. In these cases, we may need to consider draining the effusion as well as considering an option that would provide continuous drainage, such as a pericardial drain or a pericardial window. And then finally, for patients with malignant pericardial effusion, their exudative effusion, which is caused by the cancer. is often going to reoccur and may be symptomatic. In these cases, palliative drainage may help to improve symptoms for them and quality of life, but just as with the other recurring or persistent effusions, The drainage here, we're going to want a longer-term solution that's probably going to be needed.

Again, a pericardial drain or pericardial window. All right, and then lastly, let's just review over the methods to drain the effusion. So I just hit on all of these as I went through the previous list here, but I do want to concisely group them together so that we can quickly talk about the different ways in which we can drain the pericardial effusion.

So the primary way to do so is with a pericardiocentesis. So this involves the insertion of a needle into the pericardial sac and then draining fluid this way, as well as collecting a sample for testing if it's needed. The goal is to remove the fluid and volume from the pericardial space and restore hemodynamic stability and to reduce or eliminate any symptoms for the patient. So this is going to require the guidance of an echo to ensure the proper placement of the needle without causing damage to the heart itself.

This is typically done with a local anesthetic, and their approach is either subxiphoid, parasternal, or apical, really depending on the location and position of the effusion. Now once the needle is in the pericardial sac, a catheter can actually be inserted and advanced in order to continue draining the fluid. Now on this subject, oftentimes once this fluid is drained, this catheter is removed. But in some cases, especially for cases where there's concern for redevelopment of the effusion, that this catheter can be left in place, and then the patient may remain with a pericardial drain.

So this is going to allow for us to fully drain and prevent reaccumulation of fluid in this pericardial space, and this is also helpful in pericardial effusions that result from pericarditis. Fully draining this purulent fluid can help to prevent loculated pockets that can really complicate treatment. Now with this drain in place, we can closely monitor the amount.

characteristics and consistency of the draining fluid. This combined with regular imaging can help to guide the decision for how long to leave this drain in place. That said, the pericardiocentesis and the subsequent placement of a drain is certainly not without risk, both in terms of damage to the heart and the surrounding structures, as well as infection, especially with the drains. Now, surgical management of the effusion may be required for some very different reasons here. First, if the fusion is a result of bleeding, so whether it's one of those iatrogenic causes, surgery, trauma, this is oftentimes going to require surgical intervention to fix and stop the bleeding.

In these cases, post-op, we're actually going to have another type of drain in place that we call mediastinal chest tubes, which are going to be connected to a typical chest tube drainage system. Now also, as previously mentioned, another surgical intervention that we can do is a pericardial window. And this is actually a minimally invasive surgery that creates a small hole or window in the pericardium to allow the fluid to drain into the pleural cavity.

And then a pleural chest tube may be placed in order to help drain the fluid from the pleural space. All right, that about covers the different aspects of pericardial effusion. Hopefully you now have a better understanding of what a pericardial effusion is, as well as the anatomy and pathophysiology. the effusion and how they can cause symptoms in our patients as well as serious risks that come along with them and finally you should have a better understanding of when and how we intervene to treat these patients including the different ways we might do so so I hope that you guys found this information useful if you did please leave me a like on the video down below it really helps YouTube know to show this video to other people out there as well as leave me a comment down below I love reading the comments that you guys leave and I try to respond to as many people as I can Make sure you subscribe to this channel if you haven't already, and a special shout out to the awesome YouTube and Patreon members out there. The support that you're willing to show me and this channel is truly appreciated, so thank you guys so very much.

If you'd be interested in showing additional support for this channel, you can find links to both the YouTube and Patreon membership down below. Head on over there and check out some of the perks that you guys get for doing just that, as well as check out some of the links to other nursing gear, as well as some awesome t-shirt designs I have down there as well. Make sure you guys stay tuned for the next lesson that I release.

Otherwise, in the meantime, here's a couple awesome lessons I'm going to link to right here. As always, thank you guys so much for watching. Have a great day.

Transcript for:Understanding Pericardial Effusion and Management

Transcript for:
Understanding Pericardial Effusion and Management