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Apical approach Pericardiocentesis It’s my favorite approach to tapping the pericardial space. All you need is a 21G and echo. Sometimes poor patient windows or body habitus may limit you! Keys: 🔊Use echo to understand your best apical window. I tend to do the imaging my self to start to understand the direction and beam of echo (your window) 👈🏽Set up your table on the patients left side 💉Always use a micropuncture needle (attach a 3 cc filled with lidocaine and inject as you advance) 🔝Always stay above the rib 🐌Small micro movements (usually advancing the needle with my left hand closest to the skin 🦴Once in the space use a 0.018 Nitrex wire and watch it cross the spine 🫧Put in micropuncture dilator and do a bubble study to confirm placement ⛓️‍💥I now generally always place a radial glide sheath in over the nitrex and then the 6F drain through the sheath 🧪Send 60cc for study and then attach the angio-vac accordion system 💤Leave drain in place. Get limited echo in am #cardiology #cardiox #cardiology