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Course: Oncology Nursing

Topic: Nursing Management of

Oncological Emergency Cardiac Tamponade

The Nurses International Community

Contact info: info@nursesinternational.org

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Contact info: info@nursesinternational.org

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Module Goals

Learners will be able to:

Explain the underlying pathophysiology of cardiac tamponade.
Describe the scope of the problem including the incidence, etiology and risk factors for this oncologic emergency.
List the clinical manifestations that are associated with this emergency situation.
Explain the nursing assessment for cardiac tamponade.
List the nursing role to address cardiac tamponade in a timely and effective manner.

Contact info: info@nursesinternational.org

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Cardiac Tamponade

MedlinePlus, 2020; Stashko & Meer, 2020

A medical emergency where fluid/blood accumulates in the pericardial sac and start to compress the heart. This can ultimately result in decrease in cardiac output and shock.

Mortality rate is 80% in a year for malignant cause where for non-malignant cause is less than 15%

It needs immediate medical attention!!

Contact info: info@nursesinternational.org

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Cardiac Tamponade (Etiology)

Happens when fluid like exudate, transudate or blood builds into the pericardial space.
Fluid can accumulate due to several reason.
Hemorrhage: Penetrating wound to heart, gun shots, ventricular wall rupture.

Dissecting aortic aneurysm
Heart attack/ heart failure
Heart surgery

Stashko & Meer, 2020

Contact info: info@nursesinternational.org

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Cardiac Tamponade (Etiology)

Invasive heart procedures: placement of central lines
Pericarditis: Caused by bacterial or viral infections like TB, autoimmune diseases, neoplasms,
Lung Cancer (End Stage)
Heart tumors
Leukemia
Radiation therapy to the chest
Underactive thyroid gland

Stashko & Meer, 2020

Contact info: info@nursesinternational.org

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Cardiac Tamponade (Epidemiology)

Prevalence is unknown: Higher incidence are seen in:

HIV patients
End stage renal disease
History of heart failure
Malignancies
TB
Autoimmune diseases
Traumatic injuries to the chest

Stashko & Meer , 2020

Contact info: info@nursesinternational.org

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What would the nurse do?

A 42 -year-old man who recently received radiation therapy of the chest presents in ER with confusion, complaining of thoracic and abdominal pain.

He developed tachycardia (120 bpm), tachypnea (32 breaths per minute), hypotension, cool and clammy extremities with marked peripheral hypoperfusion.

What is your diagnosis for the patient?

Contact info: info@nursesinternational.org

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Cardiac Tamponade (Pathophysiology)

MedlinePlus, 2020

Stashko & Meer, 2020

Contact info: info@nursesinternational.org

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Cardiac Tamponade (Signs and Symptoms)

MedlinePlus, 2020

Anxiety, Restlessness
Sharp chest pain on back, neck, shoulder, abdomen (worsen with breathing and coughing)
Difficulty and rapid breathing
Lightheadedness and fainting
Palpitation
Swelling of legs and abdomen
Jaundice
Dizziness
Drowsiness
Faint pulse or no pulse

Contact info: info@nursesinternational.org

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Cardiac Tamponade (Exams and Tests)

Physical exams may show:

Blood pressure that falls when breathing deeply
Rapid breathing
Heart rate over 100 (normal is 60 to 100 beats per minute)
Heart sounds are only faintly heard through a stethoscope
Neck veins that may be bulging (distended) but the blood pressure is low
Weak or absent peripheral pulses

MedlinePlus, 2020

Contact info: info@nursesinternational.org

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Cardiac Tamponade (Exams and Tests)

MedlinePlus, 2020

Echocardiogram will help diagnose cardiac tamponade

Other tests may include:

Chest X-ray
Chest CT or MRI
Coronary Angiography
ECG
Heart catheterization (Right)
Blood work: Creatine kinase levels, renal profile, coagulation profile, antinuclear antibody tests, ESR, HIV testing and PPD skin test

Contact info: info@nursesinternational.org

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Cardiac Tamponade (Treatment and Management)

Stashko & Meer , 2020

Initial Management:

Provide oxygen
Volume expansion
Bed rest with elevated legs
Fluids to keep blood pressure normal
Medicines to increase blood pressure
If possible, avoid positive mechanical ventilation
Treat the cause

Contact info: info@nursesinternational.org

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What would the nurse do?

Patient DB, is a 38 year old female with stage 4 anal cancer s/p loop ileostomy for fecal diversion with adjuvant chemotherapy and radiation. She presents to the ER with new symptoms of dyspnea and shortness of breath.

Vital Signs are as follows: BP 100/58; HR 100; Pulse Ox 89% on Room Air; RR 22.

Physical Exam reveals slight Jugular Vein Distention and mild facial swelling. Auscultation of the heart reveals muffled heart sounds. Lungs are clear, slightly diminished in the bases.

What should the next steps be?

Contact info: info@nursesinternational.org

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Cardiac Tamponade (Definitive Treatment)

Needle Pericardiocentesis

Also called Pericardial Tap.
Performed at bedside with a needle to drain the fluid in pericardial space.
Traditional landmark technique or echocardiogram is used for the placement and to guide needle.
Often gives immediate effect by decreasing the intrapericardial pressure and arterial pressure.
The drained fluid helps to increase stroke volume.

MedlinePlus, 2020; Stashko & Meer, 2020

Contact info: info@nursesinternational.org

Cardiac tamponade is a medical emergency and has to be treated in the hospital.

The main treatment is the removal of the pericardial fluid so that the heart gets relief from the pressure.

Needle pericardiocentesis: The procedure is done at the bedside with a needle (to guide the needle it can be done either by traditional landmark technique or with the help of echocardiogram). This procedures often gives immediate effect by decreasing the intrapericardial and arterial pressure, increasing stroke volume

Surgical pericardiectomy or pericardial window: Another method includes surgical removal of pericardium. It is done by performing thoracotomy and the opening of the pericardial sac. It can be done during the traumatic arrests with suspected or confirmed case of cardiac tamponade. In caseof traumatic pericardial effusion, surgical method is preferable than the needle pericardiocentesis.

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Cardiac Tamponade (Definitive Treatment)

Surgical Pericardiotomy

Also called pericardial window.
Done by performing thoracotomy and the opening of the pericardial sac.
Part of pericardium can be cut and removed .
Done during the traumatic arrests with suspected or confirmed case of cardiac tamponade.
In case of traumatic pericardial effusion, surgical method is preferable than the needle pericardiocentesis.

MedlinePlus, 2020; Stashko & Meer, 2020

Contact info: info@nursesinternational.org

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Role of Nurses During Cardiac Tamponade

Must be handled by interprofessional team of clinician and nurses.
Be aware as it can lead to hypotension, shock or death.
Provide oxygen, elevate the legs, perform cannulation with large bore needle until team arrives.
Inform ICU about the case and transfer.
Keep patient in cardiac monitor.

Stashko & Meer, 2020

Contact info: info@nursesinternational.org

As it is an emergency that can lead to hypotension, shock and death. Therefore, it should be handled with interprofessional team of clinicians and nurses.

As a nurse, he/she must be aware of this condition

Once the patient is in the emergency room, a nurse must provide oxygen, elevate legs, perform cannulation with large-bore needles while waiting for the team to arrive

As the patient might need ICU, ICU has to be pre-informed about the case and transfer

Patient has to be kept in cardiac monitor for close observation

If the team confirms the surgical management or pericardial decompression, operation theater has to be informed ASAP.

After any kind of procedure/treatment/management, patient has to be in close observation. Patient has to be watched for re-accumulation of fluid in pericardial space

If a drain is left in the pericardial sac, the nurse should monitor the drainage for amount, color, odour. Nurse is also responsible for ensuring the correct placement of drainage.

A clear open communication should be maintained between the healthcare team so that there is no any confusion or delay in treatment

Before the patient is discharge, a follow-up echo has to be done to see the condition of the heart.

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Role of Nurses During Cardiac Tamponade

Inform operation theater as it might need surgical operation
Watch for the re-accumulation of fluid.
If patient has drainage, ensure the correct placement of the drain: note color, amount, odour of the drain.
Maintain a clear and open communication between healthcare team.
Ensure a follow-up echo to see the progress before the discharge.

Stashko & Meer, 2020

Contact info: info@nursesinternational.org

Cardiac Tamponade is an emergency that can lead to hypotension, shock and death. Therefore, it should be handled with interprofessional team of clinicians and nurses.