1. Identify pericardial effusion using ultrasound
  2. Identify indication for emergent pericardiocentesis (cardiac tamponade)
  3. Position patient appropriately (head of bed elevated 30 degrees if possible)
  4. Identify anatomic landmarks (xiphoid process, left costal margin, left shoulder)
  5. Inject local anesthesia at needle insertion site as situation permits
  6. Prepare chest wall, apply sterile drapes and sterile ultrasound probe cover as situation permits
  7. Advance 18-gauge needle at appropriate location, angle and depth
  8. Demonstrate ability to follow need in and out of plane
  9. Aspirate pericardial fluid
  10. Place pigtail drain using Seldinger technique if needed
  11. Order chest x-ray to evaluate for pneumothorax