Pericardiocentesis Most Common Approach: Subxiphoid Equipment: could be as simple as large bore LP needle with syringe OR a complete pericardiocentesis kit Insertion: between Xiphistemum and left costal margin Trajectory: 30-45 degrees to the skin aimed towards left shoulder - ideally performed under US guidance PEARLS: - bend needle concave upwards and insert until you hit the rib, then withdraw needle and apply downward pressure, keeping needle parallel with patient to sneak needle underneath rib and into pericardium (similar to subclavian CVC approach) - connect needle to IV tubing and 3-way stopcock to allow "push-pull" technique for easier drainage of large effusions - MH/CCF/CWRU EM Res @MetroHealth_EM #Pericardiocentesis #instructions #management
