Pericardial drainage is generally required for diagnosis and treatment of patients with pericardial effusion, and often for associated cardiac tamponade. Various effective techniques of drainage are available, each with different advantages and disadvantages; no single technique is optimal for all patients and circumstances. Pericardiocentesis or percutaneous tube drainage may be useful for patients with acute tamponade, although these carry significant risks and are safest when done under controlled conditions in the catheterization laboratory. Our preferred method of pericardial drainage in the majority of patients is the subxiphoid approach. This technique allows rapid access to the pericardium and is associated with low morbidity and excellent long-term results. Patients with infectious pericarditis should be monitored closely following pericardial drainage, and early pericardiectomy may be required, especially in children with H. influenzae. Extensive pericardiectomy by either sternotomy or thoracotomy should be reserved for patients with pericardial constriction or failures of pericardial window.