Nursing care of a patient after pericardiocentesis in terms of the International Classification of Nursing Practice ICNP® – a case study

INTRODUCTION

The historical origins of the pericardiocentesis procedure date back to 1653, when Riolamus concluded that a pathological amount of fluid could accumulate in the pericardial cavity, interfering with physiological myocardial function. The researcher identified invasive sternal trepanation as a therapeutic method. The first documented report of a needle puncture of the pericardial sac and decompression of accumulated fluid in the pericardial cavity dates back to 1840, described by Austrian surgeon Franz Schuh [1]. Currently, this procedure is performed to remove pathological amounts of accumulated fluid or blood in the pericardial cavity, as well as for diagnostic purposes or for therapeutic indications in oncology. The introduction of echocardiographic imaging has made a significant contribution to the development of the procedure’s technique, serving as an essential surveillance tool. Typical features of fluid or blood presence in the pericardial sac, as imaged by echocardiography, include: abnormal persistence of plaque separation during myocardial diastole in a patient lying in the left lateral position. Initially, free fluid is located behind the posterior wall of the left ventricle, in the oblique sinus of the pericardial sac, and when abundant, it is also visible along the other walls of the myocardium [2].
Indications for pericardiocentesis:
• cardiac tamponade,
• suspected purulent pericarditis,
• suspected neoplastic pericarditis,
• large amount of fluid in the pericardial sac without a positive response to the implemented drug treatment,
• administration of cytostatic drugs into the pericardial sac [3].
Absolute contraindications to pericardiocentesis:
• aortic dissection,
• left ventricular pseudoaneurysm rupture,
• chest wall penetrating wounds.
Relative contraindications to pericardiocentesis:
• uncompensated coagulation disorders,
• anticoagulant treatment,
• thrombocytopaenia,
• small pericardial fluid reservoirs in the posterior pericardial cavity [4].
Prior to performing the procedure, the patient’s informed consent must be obtained and continuous monitoring of baseline vital signs using a cardiac monitor must be ensured. Available scientific sources describe 3 main techniques for performing pericardiocentesis, which include the following:
• subcostal access technique,
• parasternal access technique,
• apical access technique [5].
The performance of the procedure requires appropriate preparation of the patient and medical staff, observing aseptic and antisepsis principles. It is a procedure performed in a highly sterile manner. The skin in the surgical field should be anaesthetised with an epidural to minimise discomfort associated with pain [6].
The technique of the subcostal access procedure consists of inserting a sterile needle between the myelomeningocele and the edge of the left rib arch at an angle of 30-45° to the plane of the skin, directing the needle towards the left shoulder while aspirating the syringe plunger under echocardiographic guidance. Insert the catheter along the guidewire and then remove the guidewire. The catheter tip should be properly secured. Fluid should be evacuated in stages to prevent right ventricular myocardial dilatation. The catheter is classically removed if the volume of drained fluid is less than 25 ml/day [7].
The parasternal access technique involves inserting a sterile needle into the fifth intercostal space under echocardiographic guidance, in a direction opposite to the sternal edge, while avoiding the lower intercostal edge to bypass important blood vessels. Further steps of the procedure are analogous to the subcostal access technique [8].
The apical access procedure technique is the least frequently performed and consists of inserting a sterile needle into the intercostal region 1 cm lateral to the site where the apical impingement can be palpated, then the needle is directed towards the right shoulder [9].
The pericardiocentesis procedure is a relatively safe procedure, with statistics stating that complications occur after 0.05% of procedures performed [10]. The most common perioperative complications include:
• myocardial perforation,
• coronary artery perforation,
• cardiac arrhythmias,
• pneumothorax,
• iatrogenic infections [11].
The aim of this study is to present the nursing process of a patient after pericardiocentesis using the terminology of the International Classification of Nursing Practice ICNP^®.

CASE STUDY

The study used the case study method and the technique of interviewing, observing, measuring, and analysing the patient’s medical records. The study was conducted in the Department of Cardiology (Haemodynamics) in January 2024 and involved a 51-year-old man hospitalised for elective angioplasty of the left anterior descending branch of the left coronary artery. Informed consent was obtained from the patient to participate in the study, as well as relevant con-sent from the facility where the patient was hospitalised. The patient under observation was informed of the anonymity of the study, which is used for research purposes only.
The patient’s functioning of the various anatomical systems of the body was assessed:
• respiratory system: no pathological abnormalities, steady breathing, 16 breaths/min;
• cardiovascular system: heart rate 89 bpm, steady, well-tensioned, blood pressure 136/78 mmHg, saturation 98%;
• gastrointestinal tract: weight 74 kg, height 178 cm, body mass index (BMI) = 23.34 kg/m², oral cavity without pathological changes;
• genitourinary system: without abnormalities;
• nervous system: full consciousness, verbal-logical contact preserved, sleep-wake rhythm preserved;
• sensory organs: without pathological disturbances;
• musculoskeletal system: without complaints;
• assessment of the skin: good hygienic condition, skin well-groomed, without damage, temperature, tension, and colouring normal, body temperature 36.8°C.
The results of venous blood laboratory tests performed on admission of the patient to the ward were mostly normal, but abnormal values of 3 parameters were registered: peripheral blood morphology WBC – 13.13/10³/µl (4.00-10.00); RBC – 5.53/10⁶/µl (4.00-5.50); and Troponin T hs (hs-cTnT) – 0.036 ng/ml (0.00-0.014).
On the first day of hospitalisation after angioplasty of the left anterior descending branch of the coronary artery in the haemodynamics laboratory, the patient returned to the ward. The physician on duty reported that during the coronary revascularisation procedure, a complication in the form of vessel dissection had occurred. Two drug-eluting stent (DES) coronary stents were implanted (DES Xience PRO 2.5/38 mm, 16 atm., DES Promus Select 2.5/38 mm, 16 atm. and PK Papyrus to close the perforated vessel). During coronary angiography, a significant lesion was found in the left anterior descending coronary artery (LAD) – significant stenosis in the middle segment.
The patient’s condition was assessed as stable but requiring intensive cardiac monitoring. Electrocardiography was performed, and the patient was connected to a cardiac monitor. A follow-up echocardiogram showed the heart cavities were not dilated, thickened left ventricular walls, episodic left ventricular wall motion abnormalities – hypokinesia of the apical segment of the lateral wall and apical segment of the anterior wall, left ventricular EF LV ejection fraction of approximately 51%, fibrosis of the valve leaflets, impaired left ventricular relaxation, and the presence of fluid in the pericardial sac – fluid layer thickness 2 cm, estimated fluid volume 450 ml.
The patient’s condition worsened – dyspnoea increased, so oxygen therapy with an intranasal catheter was administered; blood pressure dropped to 90/50 mmHg and cardiac dysfunction in the form of bradycardia (heart rate – 48 beats/min) appeared. The treatment team decided to perform pericardiocentesis as a matter of urgency. The patient was prepared for the procedure, and informed consent was obtained. The ward physician performed a pericardial puncture using a subcostal technique under echocardiography guidance and inserted a decompression system. Approximately 400 ml of bloody fluid was evacuated. The patient’s condition improved significantly. On the third day, the patient was discharged from the ward without any complications from the body.

NURSING PROCESS

The nursing process uses the International Council of Nursing Classification (ICNP^®), which is a set of nursing terms that facilitates communication between healthcare professionals, and it makes a real difference to the quality of services provided [12]. ICNP^® covers a variety of terms related to nursing practice, describing patients’ health problems, nursing interventions, and care outcomes. With a single classification system, nurses around the world can communicate effectively, plan care, and monitor patient progress. The nursing process is included in Table 1.

DISCUSSION

Pericardiocentesis is an interventional procedure that can be used to treat a variety of heart conditions. After this procedure, patients requires special nursing care to monitor their health and provide emotional support. One of the key tasks of the nursing staff is to systematically check the patient’s vital parameters, such as blood pressure, heart rate, oxygen saturation and respiratory rate. Thanks to regular observations, it is possible to quickly respond to any complications that may arise after the procedure.
It should be emphasised that nursing care after pericardiocentesis is not limited to monitoring vital signs. An important element is to provide the patient with comfort and emotional support during the recovery period. According to scientific research conducted by Stolz et al., an empathetic approach to the patient and active listening will help build appropriate trust, which is a therapeutic pillar [13].
In the context of comprehensive care after pericardiocentesis, it is also important to provide the patient with appropriate education regarding continuation of treatment and lifestyle changes that may affect the further prognosis. According to research by Mohammed et al., regular check-ups and health monitoring are crucial to maintaining the proper functioning of the cardiovascular system after pericardiocentesis [14].
Appropriate nursing care after pericardiocentesis is crucial for the patient’s quick recovery and prevention of potential complications. Close monitoring of vital signs, providing emotional support, and patient education are an integral part of comprehensive care that should be provided by qualified and experienced nursing staff. There is one limitation in this study that may be addressed in future attempts to address a similar topic: scientific considerations can be enriched by the analysis of specific protocols and standards of nursing care after pericardiocentesis and include recommendations for rehabilitation and prevention of complications after the procedure. Additionally, it could be useful to include the patient’s own views on the quality of nursing care to better understand their perspective and needs during the recovery period.

CONCLUSIONS

The nursing process presented for a patient undergoing a pericardiocentesis procedure, based on International Classification of Nursing Practice ICNP^® reference terminology, reflects the patient’s key nursing problems and the range of interventions undertaken by the nursing staff. The evaluation carried out showed beneficial changes in the patient, especially in terms of cardiovascular function. The dangerous risk of complications of fluid accumulation in the pericardial sac was minimised, and basic vital signs normalised. The procedure proceeded without complications from the body. The patient was discharged from the ward in good condition.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The authors declare no conflict of interest.

References