INDICATIONS
Used to evacuate abnormal fluid collections from the joint space for synovial fluid analysis
Septic arthritis
Crystal arthropathy
Hemarthrosis
Inflammatory process
Used to diagnose occult fracture or ligamentous injury
Used to decrease/relieve pressure in the joint to provide pain relief
Used to inject methylene blue and test for joint capsule integrity when concerned that overlying laceration communicates with joint space
Used to inject medication for treatment and pain relief
CONTRAINDICATIONS
Absolute Contraindications
Abscess/cellulitis in the tissue overlying the site to be punctured (often infectious arthritis can mimic an overlying soft-tissue infection)
Relative Contraindications
Bleeding diatheses/anticoagulant therapy
Prosthetic joint
Known bacteremia
RISKS/CONSENT ISSUES
Potential for introducing infection (sterile technique must be utilized)
Procedure can cause pain (local anesthesia will be given)
Needle puncture can cause localized bleeding
Reaccumulation of fluid may occur
Risk of injuring articular cartilage with needle tip
General Basic Steps
Identify landmarks and prep area
Sterilize
Analgesia
Aspirate
LANDMARKS
Parapatellar Approach
Can use medial or lateral approach
Enter 1 cm from the edge of the patella along the superior one-third of the medial or lateral border
Direct the needle along the inferior surface of the patella and toward the intercondylar notch (FIGURE 55.1)
FIGURE 55.1 Medial parapatellar approach. (From Simon RR, Brenner BE. Emergency Procedures and Techniques. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:245.)
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