Image-guided drainage of pericardial effusions in oncology patients

The purpose of this study was to report our clinical experience with image-guided drainage of pericardial effusions in oncology patients. IRB approval was obtained for this retrospective, HIPAA-compliant study. From November 2002 to January 2008, 40 patients underwent 43 image-guided drainages of pericardial effusions. The medical records were reviewed to analyze the technical aspects of the procedures, complications, and clinical outcomes. Thirty-three pericardial drains were placed and 10 pericardiocenteses were performed. The technical success rate was 100%. Thirty-three procedures were performed under computed tomographic (CT) guidance, five under ultrasound (US) guidance, and five using both CT and US guidance. There were no technical, procedure-related complications. Delayed postprocedure complications and arrhythmias occurred in 11 cases, for an overall complication rate of 25.6%. All complications occurred in patients who had undergone drain placement. Nine patients developed new or worsening arrhythmias and six of these patients required transfer to a higher level of care or the initiation of pharmacological management. In 58.6% of drain placements, including 4 of 11 patients who developed complications, the catheter could have been removed earlier. The median overall survival was 6.47 months (95% CI: 2.37, 12.7). In conclusion, image-guided pericardial drain placement is safe and feasible. Due to the frequency of delayed postprocedure arrhythmias, follow-up monitoring in a telemetry unit is recommended. Prompt catheter removal after drainage may reduce the incidence of delayed post-catheter-insertion arrhythmias.