Editing Pericardial window (section)

== Closed pericardiocentesis: ==

* Para-apical needle insertion with echocardiographic guidance to assess completeness
* Can also be done sub-xiphoid (lower risk of PTX, but higher risk of damage to intra-abdominal organs). May be difficult in obese patients. 
** Sub-sternally 1cm inferior to left xiphocostal angle
** Once below the cartilage cage, lower the needle to 30 degrees
** Aim towards left mid-clavicle and advance slowly while continuously aspirating
** In most cases, 7-9cm will be adequate, but needles up to 12cm may be needed in obese patients
** If no fluid obtained, withdraw to skin and advance along a more posterior track
** If no fluid still obtained, redirect 10 degrees towards the right and try again, until the needle is aimed toward the right neck
* Remove 50-100mL to assess for improvement
* Insert guidewire and upsize to pigtail catheter