Percutaneous pericardiocentesis was introduced during the 19th century and became a preferred technique for the management of pericardial effusion by the early 20th century. Until the era of two-dimensional echocardiographically guided pericardiocentesis, however, the procedure was essentially "blind," and serious complications were comparatively common, an outcome that resulted in an increased preference for surgical solutions. Because two-dimensional echocardiography facilitates direct visualization of cardiac structures and adjacent vital organs, percutaneous pericardiocentesis can be performed with minimal risk. Since its inception in 1979 (19 years ago), the echocardiographically guided pericardiocentesis technique has continued to evolve. Important procedural adaptations and modifications that optimize safety, simplicity, and patient comfort and minimize the recurrence of effusion have been defined and incorporated. This technique has been proved to be safe and effective. A detailed step-by-step description of the procedure and the necessary precautions to optimize success and safety is presented herein.