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Mnemonic

Pericardiocentesis Approach

A memory aid for the subxiphoid approach to the pericardium.

Anatomy Cardiology Emergency Thorax Pericardial and Myocardial Disease Resuscitation and Cardiac Arrest
Expansion

Enter at Larrey's point, left of the xiphoid, aiming for the left shoulder at 30 degrees

Expansion

  • Entry point - Larrey’s point, in the angle between the xiphoid process and the left costal margin
  • Angle - about 30 degrees to the skin
  • Direction - towards the left shoulder (or the left mid-clavicle)
  • Aspirate continuously while advancing

The route works because the pericardium extends inferiorly and is fused to the central tendon of the diaphragm, so an effusion pools in the dependent portion and can be reached from below without crossing the pleura.

Structures at risk are the left internal thoracic artery if entry is too lateral, the liver if the angle is too steep, and the right ventricle - the most anterior chamber, if the needle is advanced too far.