Ateneo de Zamboanga University College of Nursing

NUSING SKILLS OUTPUT (NSO) Report No. _11_ ARTHROCENTESIS I. DESCRIPTION: Arthrocentesis is the removal of the synovial fluid that lubricates your joints. Doctors perform arthrocentesis using a needle and syringe. The fluid is removed and tested to diagnose the cause of a buildup of fluid. Causes include infection, arthritis, and joint injury. Doctors also use arthrocentesis to treat joint pain by removing excessive or infected fluid. Arthrocentesis is performed in many joints, including the elbow, knee, hip and jaw. Arthrocentesis is only one method used to diagnose or treat a variety of joint conditions, most often of the knee. Consider getting a second opinion about all of your treatment choices before having an arthrocentesis. II. MATERIALS/ EQUIPMENT NEEDED: -Skin cleansing agent (e.g., chlorhexidine or povidone-iodine) -Sterile gauze -Local anesthetic (1% lidocaine is acceptable) -Small (e.g., 5 mL) syringe with 25-gauge needle for anesthetic injection -Syringe (30-60 mL for large effusions) with an 18-gauge needle for joint aspiration -Specimen tubes for submission of synovial fluid to the laboratory; typically, an EDTA tube is used for cell count and differential, and a lithium heparin tube is used for crystal examination. -Bandage -Elastic Wrap (to be applied after large joint aspirations) -Gloves III. PROCEDURE 1. You remove clothing from the affected joint or you dress in a patient gown. 2. You lie on the examination table to allow access to the joint. 3. You may have sedation to make you drowsy and relaxed, and possibly a pain medication. This is common for infants and children. You may have general anesthesia for arthrocentesis of the jaw. Your care team uses monitoring devices to watch your vital signs if you have sedation or general anesthesia. 4. Your doctor cleans and numbs the joint and surrounding area with a local anesthetic. 5. Your doctor inserts a needle into the joint space and withdraws a portion of synovial fluid into a syringe. The needle may be guided to the proper position using imaging technology if the joint is difficult to access, such as a hip joint.

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6. Your doctor detaches the syringe of synovial fluid from the needle and replaces it with a syringe of medication, if needed. The medication is injected into the joint. 7. Your doctor removes the needle and cleans and bandages the area. 8. The synovial fluid is sent to the laboratory for testing. Your doctor will discuss the results with you at a later time.

IV. DIAGRAM/ ILLUSTRATIONS:

V. NURSING RESPONSIBILITIES: 1. BEFORE PROCEDURE Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general). Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking. Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure. If you are pregnant or suspect that you are pregnant, you should notify your health care provider. Generally, no prior preparation, such as fasting or sedation is required. However, if fluid is taken from the joint to be tested in a lab, you may be asked to fast for a certain period of time before the procedure. Based on your medical condition, your doctor may request other specific preparation.
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2. DURING PROCEDURE You will be asked to remove clothing and will be given a gown to wear. You will be positioned so that the doctor can easily reach the joint that is to be aspirated. The skin over the joint aspiration site will be cleansed with an antiseptic solution. If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging sensation. The doctor will insert the needle through the skin into the joint. You may feel some discomfort or pressure. The doctor will remove the fluid by drawing it into a syringe that is attached to the needle. The needle will be removed and a sterile bandage or dressing will be applied. The fluid sample will be sent to the lab for examination. 3. AFTER PROCEDURE Keep the joint aspiration site clean and dry. Leave the bandage in place for as long as instructed by your doctor. The aspiration site may be tender or sore for a few days after the joint aspiration procedure. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications. Notify your doctor to report any of the following:

Fever Redness, swelling, bleeding, or other drainage from the aspiration site Increased pain around the aspiration site

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Reference: http://emedicine.medscape.com/article/79994-technique#aw2aab6b4b2 http://kidshealth.org/parent/system/medical/arthrocentesis.html http://www.healthgrades.com/procedures/arthrocentesis http://www.proceduresconsult.com/medical-procedures/arthrocentesis-knee-EM058-procedure.aspx

FEBRUARY 3, 4, 5, 2014 Date EDMUND W. RUFINO BSN III-C

MS. RAQUEL O. DE VILLA Clinical Instructors Initials

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