To the Editor.— The results of the use of local steroid instillation in intractable uremic pericarditis in 45 patients described by Buselmeier et al (240:1358, 1978) were impressive. We would like to submit the following modification for the placement of the catheter in the pericardial space. After sterile preparation of the sternum, the area below the xiphisternum is infiltrated with procaine hydrochloride. Blunt dissection is performed to expose the pericardium. This is easily accomplished, as the pericardium is superficial in this position. Then, under direct vision, a catheter is placed and positioned so that adequate fluid is easily aspirated. The steroid is then instilled in the manner suggested by Buselmeier et al. This approach has the following advantages: (1) Blind needle insertion is avoided. (2) The catheter could be placed in excellent position. (3) Chances of a traumatic hemorrhagic effusion are diminished. (4) Loculated and adhesive compartment formation is