An approach to pericardial effusion in hemodialysis patients

Cardiac tamponade from pericardial effusion in hemodialysis patients is life threatening. Precipitation of tamponade during the period of hemodialysis is common and it may occur catastrophically. Emergency pericardiocentesis may not be successful because of logistic delays or unapproachable loculation of fluid. Over a short period these problems were seen in 4 patients with one subsequent death. An approach to hemodialysis patients with pericardial effusion which may provide a method of assessing the hemodynamic significance of pericardial fluid before overt tamponade, is suggested and outlined. During dialysis three common hemodynamic changes in patients with pericardial effusion require clear separation because of different therapeutic approaches. These are: volume depletion, congestive heart failure and cardiac tamponade. Distinction is not possible with simple right atrial pressure monitoring but can be made using a Swan Ganz catheter placed in the pulmonary artery. Anterior pericardiectomy before overt tamponade is suggested in patients with hemodynamically important effusion requiring hemodialysis.