The technique of pericardiocentesis. When to perform it and how to minimize complications.

Pericardiocentesis is primarily indicated for the management of emergent cardiac tamponade. Insert the needle into the left xiphocostal angle perpendicular to the skin and 3 to 4 mm below the left costal margin (the preferred approach); advance it 5 to 10 mm (or more if necessary) until it reaches the pericardial fluid. A "giving" sensation indicates penetration of the parietal pericardium; a "ticking" one, needle contact with the heart. The needle's position may be confirmed with two-dimensional echocardiography or fluoroscopy. Use the Seldinger technique to insert a catheter for fluid drainage. Monitor the patient continuously for recurrent tamponade, which may result from catheter blockage or fluid reaccumulation.