CPT® Code 76930

Deleted

1. Indications

The procedure of ultrasonic guidance for pericardiocentesis is indicated for the following conditions:

• Pericardial Effusion - This condition involves the accumulation of fluid in the pericardial space, which can lead to cardiac tamponade and requires intervention to relieve pressure on the heart.
• Cardiac Tamponade - A serious condition where fluid accumulation in the pericardial sac exerts pressure on the heart, impairing its ability to pump effectively.
• Evaluation of Hemodynamic Effects - The procedure is performed to assess the impact of the effusion on cardiac function and hemodynamics.

2. Procedure

The ultrasonic guidance for pericardiocentesis involves several critical procedural steps:

• Step 1: Pre-Procedure Imaging - Initially, both 2D and Doppler echocardiography studies are conducted to evaluate the pericardial effusion. This imaging helps in determining the size, distribution, and hemodynamic effects of the fluid accumulation.
• Step 2: Identifying the Entry Site - The ideal entry site for the needle is identified based on the imaging results. This site is typically where the effusion is most pronounced and closest to the ultrasound transducer, ensuring optimal access to the fluid.
• Step 3: Marking the Entry Point - Once the entry site is determined, it is marked on the skin to guide the needle insertion. The direction of the ultrasound beam is also noted to facilitate accurate needle placement.
• Step 4: Needle Insertion - After preparing the skin, a sheathed needle is introduced into the pericardial sac. This step requires careful monitoring via ultrasound to ensure correct placement.
• Step 5: Confirming Positioning - The needle is withdrawn, leaving the sheath in place. The correct positioning of the sheath within the pericardial sac may be confirmed using saline echo contrast, which is monitored by ultrasound.
• Step 6: Catheter Placement - A catheter is then placed into the pericardial sac through the sheath. The position of the catheter is confirmed by ultrasound to ensure it is correctly situated for effective drainage.
• Step 7: Draining the Effusion - The pericardial effusion is drained through the catheter, alleviating pressure on the heart.
• Step 8: Post-Drainage Assessment - Following the drainage of the fluid, an ultrasound assessment is performed to evaluate any residual fluid in the pericardial space.

3. Post-Procedure

After the completion of the pericardiocentesis procedure, it is essential to monitor the patient for any complications that may arise, such as bleeding or infection at the insertion site. Additionally, the patient may require follow-up imaging to assess the effectiveness of the drainage and to check for any recurrence of the effusion. Continuous monitoring of the patient's hemodynamic status is also crucial to ensure that the heart is functioning properly following the procedure. Any residual fluid should be evaluated, and further intervention may be necessary if significant fluid remains.