Puncture is the collection of biomaterial 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 heart region, sometimes even saves the life of the patient. It is better to learn about the features of the 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 - internal and external. The small space between the walls of the heart muscle and the pericardium is filled with fluid. In this part of the body there can be inflammations, purulent processes, mechanical injuries.
Pericardial puncture (pericardiocentesis) is done in order to take on the analysis of the liquid. In some cases, for example, with purulent formations or an increase in the amount of fluid, the puncture becomes a curative measure.
The technique is rather complicated, the doctor must accurately determine the desired area of the heart and find the points for the introduction of the needle.
For this procedure, carried out under the monitoring of ultrasound or radiography. The method of conducting resembles a mini-operation: the patient is first examined, then anesthesia is performed, and after the procedure they are left to be supervised in the hospital.
But such an operation is transferred much more easily than a band opening of the chest. 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 manipulation is carried out with cardiac tamponade - compression of an organ with a liquid or air. If there are such indications, during the pericardiocentesis, the excess is pumped out, which improves the patient's well-being, and in urgent cases - saves lives. With pericarditis, the material is needed to determine the cause of the accumulation of exudate or blood.
The puncture is carried out in emergency situations or according to plan. Depending on the situation, the patient is prescribed several types of examination.
In case of emergency, the cardiologist decides what tests are needed before the intervention. For the routine procedure prescribed:
- chest x-ray;
- blood tests (necessarily for clotting);
Patients who undergo systematic treatment, you need to warn your doctor about all the drugs that are taken. 4-6 hours before the procedure it is forbidden to eat and drink. Be sure to tell the doctor about all the medications that have been taken in the last 24 hours.
Manipulations are carried out in several ways, such techniques were named after their inventors. Most often, the method is used according to Larrey and Marfan, they differ only in points of needle insertion. For the patient himself, it practically does not matter what the technique will be. Whichever type of pericardiocentesis is prescribed, the operation for the patient will be almost the same.
The patient changes into sterile hospital clothes or exposes the upper body. It occupies a half-sitting position on the treatment table, sometimes a pillow is placed under the back. Sedatives are injected into a vein, all other procedures are performed after 20 minutes. The chest is treated with antiseptic agents.
After determining the entry point, the doctor handles the instrument. The needle for puncture is thin; an anesthetic for local anesthesia will flow through it. First, the anesthetic is administered to anesthetize the skin, then a little deeper, up to the pericardium.
The process will be controlled by fluoroscopy or echocardiography. The doctor will slowly insert the needle, take samples and bring out the instrument. For removal of air or liquids, a catheter is inserted into the needle cavity, along which excess is brought out.
With pericarditis, the cavity can be flushed and an antibiotic with oxygen can be introduced into it. At the end of the operation, the puncture site is treated with an antiseptic, sometimes sealed with xanol.
The patient then remains under the supervision of physicians for no less than 2 hours. If drainage has been established, the hospital is extended for several days. The biomaterials are sent for analysis, another examination is carried out: a chest x-ray (to verify the integrity of the organs), a pulse and pressure check.
During such manipulations there may be complications. The heart or lungs may be damaged by puncture tools, this is considered the most severe consequence of the procedure.
This happens during 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 treatment immediately, especially difficult situations require urgent surgical intervention.
Also, when the needle is inserted, infection is possible if the instruments or the chest have not been treated with an antiseptic.
If the exudate excreted too quickly, the body is under stress, the heart does not have time to adjust to the changed pressure. It is fraught with impaired heart rhythm. It is important to monitor your well-being after pericardiocentesis, you need to consult a cardiologist if:
- chills and fever appeared;
- there are chest pains that do not go away;
- there is a causeless cough, shortness of breath, difficulty breathing;
- blood is expelled from the puncture site;
- very dizzy, nauseous;
- there was swelling, redness about the area of the puncture.
Increases the risk of complications overweight, bad habits, the shock state of the patient. If the patient has not warned the doctor about the drugs taken, blood clotting can be reduced, which will lead to serious consequences.
Recovery after puncture
For some time the patient remains in the hospital for observation. After discharge, the doctor makes recommendations for a speedy recovery. At first, after pericardiocentesis, it is strictly forbidden to lift weights, overstrain, have sex. Smoking and alcohol are excluded as much as possible, in extreme cases - for 2 weeks.
When you are discharged with a doctor, you need to consult about which medications you can take. The painkiller will be prescribed, it should be drunk in a clearly indicated dosage. At the first signs of complications, you need to 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 on slow walks, breathe fresh air. In winter, be sure to dress warmly, in the summer to exclude overheating, sunbathing on the beach. Stressful situations are especially undesirable for heart disease, they should be avoided as much as possible. For particularly sensitive cardiologists may recommend sedatives. Return to an active lifestyle is possible after the approval of the doctor.
This cardiac surgery is performed in public hospitals and hospitals. You can also pass it in cardiology clinics and medical centers in the private segment. To choose between medical institutions, you can search for reviews on the sites of private clinics. Feedback about doctors and public hospitals are in urban forums.
When choosing, it is worth considering that the private segment is better equipped, the service here adapts to the client as much as possible. In public institutions "lame" and equipment, and service. But the difference in price for such a service is quite large.
In public hospitals and hospitals, pericardiocentesis will cost 130-170 dollars, the price does not include anesthesia and additional medications. In a private clinic, the price of such a procedure will be from $ 250 to $ 500, in rare cases it may be higher. The total cost depends on the condition of the patient and the range of actions of the doctor.
Puncture is at least unpleasant. To reduce pain, anesthesia is given before the movement of the needle, but during the puncture pain is felt. There will be no catastrophic sensations, the procedure is unpleasant, but quite tolerable. Before an operation, you should calm down, think about the fact that it is necessary for a full life, possibly for salvation.