Arthrocentesis: MCP (Training Physician)

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Diagnostic evaluation of acute monoarticular or polyarticular arthritis
  • Therapeutic treatment of acute joint effusions

CONTRAINDICATIONS
  • Overlying skin infections or lesions
  • Arthrocentesis is probably safe in patients with a coagulopathy, unless the coagulopathy is severe. However, the safety of arthrocentesis in patients with abnormal coagulation is not established.
  • Bacteremia

EQUIPMENT
  • 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 (3-5 mL) with 22- or 25-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)
  • Sterile gloves, mask, goggles
ANATOMY
  • The metacarpophalangeal (MCP) joints are formed from the articulation of the carpal bones and the proximal phalanx. The interphalangeal (IP) joints are the articulations between the phalanges.
  • The extensor digitorum tendon is superior to the bones and the flexor digitorum superficialis and flexor digitorum profundus tendons are on the palmar surface of the digits.
  • The digital nerves and veins lie along the medial and lateral aspects of the digits.
  • Palpate the extensor tendon running down the midline of the dorsum of the finger. For the MCP joint, needle entry occurs just ulnar or radial to the tendon. Needle entry for the IP joint occurs on the dorsal surface medial to the extensor tendon.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Monitor for signs of infection in the region.
  • Treat suspected septic arthritis before formal diagnosis.
    • The choice of antibiotic may be made empirically, or based upon the gram stain results.
    • Intra-articular antibiotics are not recommended.
    • The joint capsule must be repeatedly drained until the effusion is cleared. Operative drainage may be needed.
  • Treatment of gout
    • High-dose nonsteroidal antiinflammatory agents, colchicine, and oral steroids may be used.
    • Antihyperuricemia treatment should be delayed.
  • Treatment of pseudogout
    • Treatment is identical to that for acute gout. Antihyperuricemic agents are not used.
COMPLICATIONS
  • Complications are uncommon.
    • Iatrogenic infection
    • Iatrogenic hemorrhage
    • Pain during the procedure
    • Reaccumulation of the joint fluid
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