an appropriate explanation of the procedure is essential for patient confidence and for very anxious patient it is better to avoid the sternum . adequate local anaesthesia is importance to minimise pain. the skin , subcutaneous tissue , and periosteum should infiltrated,with particular attention being paid to the periosteum .it important to wait until the local has had time to take effect and to test for of anaesthesia before proceeding. the patient must be warned of the possibility of suction pain before it occurs and be reassure that it will be . if suction is distressing ,slowing rate of aspiration is indicate