Pericardiocentesis and paracentesis are both procedures amenable to ultrasound guidance. Morbidity and mortality associated with pericardiocentesis has been significantly reduced by echocardiographic guidance. By allowing direct visualization of the pericardial fluid, the location of the fluid with respect to the surface, and real-time guidance of the needle and catheter the procedure can be done more safely. Further, placement of the needle and catheter in the pericardial space can be confirmed with agitated saline contrast under ultrasound visualization, improving procedural accuracy. Paracentesis with ultrasound guidance has also been shown to be more successful with lower morbidity and mortality compared to performing the procedure blind.