Large pericardial effusion may possess potential risks of hemodynamic consequences and may progress into cardiac tamponade unexpectedly. Pericardiocentesis is advisable in asymptomatic large pericardial effusion when there are signs of hemodynamic collapse on echocardiography. However, in a limited setting, the ideal equipment is rarely available. Thus, we present a case of echocardiography-guided pericardiocentesis using a central venous catheter (CVC) in a large pericardial effusion with massive pleural effusion in a rural area.