A pericardiocentesis typically takes place in the cardiac catheterization laboratory of a hospital, although increasingly it is being performed in the intensive care unit. Wherever it is performed, the physician will have immediate access to monitoring equipment, medical devices necessary for the procedure and emergency equipment.

The patient will lie down (or be placed into position, if on critical care) on the operating table with the chest elevated 30 to 60 degrees. An intravenous (I.V.) line will be inserted into the patient’s arm. The puncture site will be cleaned and sterilized, and a local anesthetic will be administered. A long needle is attached to a large sterile syringe and inserted through the chest wall and into the pericardium. The physician can view the movement of the needle on a video monitor if he or she performs an echocardiogram. Alternatively, the progress of the needle may be monitored under a fluoroscope.

Once the needle is in place, fluid is aspirated through the needle and into the sterile syringe. If more fluid must be removed (e.g., due to cardiac tamponade), then a catheter will replace the needle to extract more fluid. In some cases, the catheter may need to remain in place for one to three days to drain all the excess fluid. Any drained fluid is collected in sterile containers for analysis. After enough fluid has been extracted to relieve the symptoms, the needle or catheter is withdrawn and direct pressure is placed immediately onto the site of the incision.