B: Arthrocentesis



Knee Arthrocentesis


Alicia Blazejewski


INDICATIONS



imagesUsed to evacuate abnormal fluid collections from the joint space for synovial fluid analysis


   imagesSeptic arthritis


   imagesCrystal arthropathy


   imagesHemarthrosis


   imagesInflammatory process


imagesUsed to diagnose occult fracture or ligamentous injury


imagesUsed to decrease/relieve pressure in the joint to provide pain relief


imagesUsed to inject methylene blue and test for joint capsule integrity when concerned that overlying laceration communicates with joint space


imagesUsed to inject medication for treatment and pain relief


CONTRAINDICATIONS



imagesAbsolute Contraindications


   imagesAbscess/cellulitis in the tissue overlying the site to be punctured (often infectious arthritis can mimic an overlying soft-tissue infection)


imagesRelative Contraindications


   imagesBleeding diatheses/anticoagulant therapy


   imagesProsthetic joint


   imagesKnown bacteremia


RISKS/CONSENT ISSUES



imagesPotential for introducing infection (sterile technique must be utilized)


imagesProcedure can cause pain (local anesthesia will be given)


imagesNeedle puncture can cause localized bleeding


imagesReaccumulation of fluid may occur


imagesRisk of injuring articular cartilage with needle tip



imagesGeneral Basic Steps


   imagesIdentify landmarks and prep area


   imagesSterilize


   imagesAnalgesia


   imagesAspirate


LANDMARKS



imagesParapatellar Approach


   imagesCan use medial or lateral approach


   imagesEnter 1 cm from the edge of the patella along the superior one-third of the medial or lateral border


   imagesDirect the needle along the inferior surface of the patella and toward the intercondylar notch (FIGURE 55.1)



images


FIGURE 55.1 Medial parapatellar approach. (From Simon RR, Brenner BE. Emergency Procedures and Techniques. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:245.)

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on B: Arthrocentesis

Full access? Get Clinical Tree

Get Clinical Tree app for offline access