Pericardial Fluid Analysis
To evaluate and classify the type of fluid between the pericardium membranes to assist with diagnosis of infection or fluid balance disorder.
Pericardial fluid collected in a red- or green-top (heparin) tube for glucose, a lavender-top (EDTA) tube for cell count, and sterile containers for microbiology specimens; fluid in a clear container for cytology. Ensure that there is an equal amount of fixative and fluid in the container for cytology.
(Method: Spectrophotometry for glucose; automated or manual cell count, macroscopic examination of cultured organisms, and microscopic examination of specimen for microbiology and cytology; microscopic examination of cultured microorganisms)
|Pericardial Fluid||Reference Value|
|Glucose||Parallels serum values|
|Red blood cell count||None seen|
|White blood cell count||Less than 300 cells/microL|
|Gram stain||No organisms seen|
|Cytology||No abnormal cells seen|
DescriptionThe heart is located within a protective membrane called the pericardium. The fluid between the pericardial membranes is called serous fluid. Normally, only a small amount of fluid is present because the rates of fluid production and absorption are about the same. Many abnormal conditions can result in the buildup of fluid within the pericardium. Specific tests are usually ordered in addition to a common battery of tests used to distinguish a transudate from an exudate. Transudates are effusions that form as a result of a systemic disorder that disrupts the regulation of fluid balance, such as a suspected perforation. Exudates are caused by conditions involving the tissue of the membrane itself, such as an infection or malignancy. Fluid is withdrawn from the pericardium by needle aspiration and tested as listed in the previous and following tables.
|Appearance||Clear||Cloudy or turbid|
|Specific gravity||Less than 1.015||Greater than 1.015|
|Total protein||Less than 2.5 g/dL||Greater than 3 g/dL|
|Fluid-to-serum protein ratio||Less than 0.5||Greater than 0.5|
|LDH||Parallels serum value||Less than 200 units/L|
|Fluid-to-serum LDH ratio||Less than 0.6||Greater than 0.6|
|Fluid cholesterol||Less than 55 mg/dL||Greater than 55 mg/dL|
|White blood cell count||Less than 100 cells/microL||Greater than 1,000 cells/microL|
|LDH = lactate dehydrogenase.|
This procedure is contraindicated forN/A
- Evaluate effusion of unknown etiology.
- Investigate suspected hemorrhage, immune disease, malignancy, or infection.
Condition/Test Showing Increased Result
- Bacterial pericarditis (red blood cell [RBC] count, white blood cell [WBC] count with a predominance of neutrophils)
- Hemorrhagic pericarditis (RBC count, WBC count)
- Malignancy (RBC count, abnormal cytology)
- Post–myocardial infarction syndrome, also called Dressler’s syndrome (RBC count, WBC count with a predominance of neutrophils)
- Rheumatoid disease or systemic lupus erythematosus (SLE) (RBC count, WBC count)
- Tuberculous or fungal pericarditis (RBC count, WBC count with a predominance of lymphocytes)
- Viral pericarditis (RBC count, WBC count with a predominance of neutrophils)
Condition/Test Showing Decreased Result
- Bacterial pericarditis (glucose)
- Malignancy (glucose)
- Rheumatoid disease or SLE (glucose)
Positive culture findings in any sterile body fluid.
Note and immediately report to the requesting health-care provider (HCP) any critical findings and related symptoms. A listing of these findings varies among facilities. Timely notification of a critical finding for laboratory or diagnostic studies is a role expectation of the professional nurse. The notification processes vary among facilities. Upon receipt of the critical finding, the information should be read back to the caller to verify accuracy.
- Bloody fluid may be the result of a traumatic tap.
- Unknown hyperglycemia or hypoglycemia may be misleading in the comparison of fluid and serum glucose levels. Therefore, it is advisable to collect comparative serum samples a few hours before performing pericardiocentesis.
- Failure to follow dietary restrictions before the procedure may cause the procedure to be canceled or repeated.
Nursing Implications Procedure
- Related tests include atrial natriuretic peptide, blood gases, B-type natriuretic peptide, cancer antigens, chest x-ray, CBC WBC count and differential, CK and isoenzymes, culture and smear mycobacteria, culture blood, culture fungal, culture viral, ECG, echocardiography, α1-fetoprotein, homocysteine, LDH and isoenzymes, magnesium, MRI chest, MI scan, myoglobin, and troponin.
- Refer to the Immune System Table for related test by body system.
Refer to the Cardiovascular System Table for related test by body system.
- Positively identify the patient using at least two person-specific identifiers before services, treatments, or procedures are performed.
- Patient Teaching: Inform the patient this procedure can assist with evaluating fluid around the heart.
- Obtain a history of the patient’s health concerns, symptoms, surgical procedures, and results of previously performed laboratory and diagnostic studies. Include a list of known allergens, especially allergies or sensitivities to latex.
- Note any recent procedures that can interfere with test results.
- Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
- Obtain a list of the patient’s current medications, including over-the-counter medications, dietary supplements, anticoagulants, aspirin and other salicylates (see Effects of Dietary Supplements online at DavisPlus). Such products should be discontinued by medical direction for the appropriate number of days prior to a surgical procedure. Note the last time and dose of medication taken.
- Review the procedure with the patient. Inform the patient that it may be necessary to remove hair from the site before the procedure. Address concerns about pain and explain that a sedative and/or analgesia will be administered to promote relaxation and reduce discomfort prior to needle insertion through the chest wall. Explain that any discomfort with the needle insertion will be minimized with local anesthetics and systemic analgesics. Explain that the anesthetic injection may cause a stinging sensation. Explain that after the skin has been anesthetized, a large needle will be inserted through the chest to obtain the fluid. Inform the patient that specimen collection is performed by an HCP specializing in this procedure and usually takes approximately 30 min to complete.
- Explain that an intravenous (IV) line will be inserted to allow infusion of fluids, antibiotics, anesthetics, and analgesics.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Note that food and fluids should be restricted for 6 to 8 hr before the procedure, as directed by the HCP, unless the procedure is performed in an emergency situation to correct pericarditis. The requesting HCP may request that anticoagulants and aspirin be withheld. The number of days to withhold medication is dependent on the type of anticoagulant. Protocols may vary among facilities.
- Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
Pain, bleeding, swelling, infection, injury to the surrounding organs
- Ensure that the patient has complied with dietary, fluid, and medication restrictions prior to the procedure, as instructed. Notify the HCP if patient anticoagulant therapy has not been withheld.
- Have emergency equipment readily available.
- Have the patient void before the procedure.
- Have the patient remove clothes above the waist and put on a gown.
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement during the local anesthetic and the procedure.
- Record baseline vital signs, and continue to monitor throughout the procedure. Protocols may vary among facilities.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection online at DavisPlus. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date and time of collection, and site location.
- Establish an IV line to allow infusion of fluids, anesthetics, analgesics, or sedation.
- Assist the patient into a comfortable supine position with the head elevated 45° to 60°.
- Clip hair from the site as needed, cleanse the site with an antiseptic solution, and drape the area with sterile towels prior to the administration of local anesthesia. The skin at the injection site is then anesthetized.
- The precordial (V) cardiac lead wire is attached to the cardiac needle with an alligator clip. The cardiac needle is inserted just below and to the left of the breastbone, and fluid is removed.
- Monitor vital signs every 15 min for signs of hypovolemia or shock. Monitor electrocardiogram for needle-tip positioning to indicate accidental puncture of the right atrium.
- The needle is withdrawn, and slight pressure is applied to the site. Apply a sterile dressing to the site.
- Monitor the patient for complications related to the procedure (e.g., allergic reaction, anaphylaxis).
- Place samples in properly labelled specimen containers, and promptly transport the specimens to the laboratory for processing and analysis.
- Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
- Instruct the patient to resume usual diet and medications, as directed by the HCP.
- Monitor vital signs and cardiac status every 15 min for the first hour, every 30 min for the next 2 hr, every hr for the next 4 hr, and every 4 hr for the next 24 hr. Take the patient’s temperature every 4 hr for 24 hr. Monitor intake and output for 24 hr. Notify the HCP if temperature is elevated. Protocols may vary among facilities.
- Observe/assess the patient for signs of respiratory and cardiac distress, such as shortness of breath, cyanosis, or rapid pulse.
- Continue IV fluids until vital signs are stable and the patient can resume fluid intake independently.
- Inform the patient that 1 hr or more of bed rest is required after the procedure.
- Observe/assess the puncture site for bleeding or drainage and signs of inflammation each time vital signs are taken and daily thereafter for several days. Report to HCP if bleeding is present.
- Observe/assess for nausea and pain. Administer antiemetic and analgesic medications as needed and as directed by the HCP.
- Administer antibiotics, as ordered, and instruct the patient in the importance of completing the entire course of antibiotic therapy even if no symptoms are present.
- Recognize anxiety related to test results, and offer support. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services, if appropriate.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
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