Five uremic patients with hemodynamically significant pericardial effusion, which did not respond to conservative treatment (intractable effusion) or tamponade, were treated with instillation into the pericardial sac of a nonabsorbable steroid, triamcinolone hexacetonide, and with intermittent drainage. This was done by insertion of a drainage catheter into the pericardial space under direct vision by subxiphoid pericardiotomy performed under local anesthesia. All patients responded well to the procedure, and immediate relief of the symptoms was achieved. No complications of the procedure were observed, and the drainage catheters were removed 48 to 72 h thereafter. Two patients died of unrelated causes--1 month and 3 years after the events. Two other patients are still alive and on a hemodialysis program, and one has a functioning kidney graft. During the 3 to 8 years of follow-up, no recurrent pericarditis was observed, and no constrictive pericarditis developed in any patient.