Anatomy of the Pericardial Space and Pericardiocentesis

The pericardial sac contains the heart and the roots of the great vessels. It has two layers, a serous visceral layer (also known as epicardium when it comes into contact with the myocardium) and a fibrous parietal layer, and encloses the pericardial cavity. Pericardiocentesis can be done by subcostal, left parasternal and apical approaches (see text). For the subcostal approach (illustrated), the needle is introduced 1cm below the left xiphocostal angle, and then advanced slowly at an angle of 30° to the skin, aiming for the left shoulder.