Elbow Arthrocentesis Periprocedural Care

Updated: Apr 18, 2017
  • Author: Susan C Bork, MD; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

Equipment

Equipment used for elbow arthrocentesis includes the following:

  • Sterile gloves and towels
  • Skin cleanser (povidone-iodine, chlorhexidine)
  • Local anesthetic agent (lidocaine 1%, vapor coolant)
  • Small (25 gauge) needle and small (5 mL) syringe for anesthetic injection
  • Needle (18-20 gauge) and syringe (5 or 10 mL) for joint aspiration
  • Specimen tubes (ethylenediaminetetraacetic acid [EDTA] for cell count and differential, lithium heparin for crystals, and a culture tube)
  • Sterile gauze
  • Elastic wrap, if needed
Next:

Patient Preparation

Anesthesia

The synovial membrane contains pain fibers; therefore, customary practice is to instill a local anesthetic before the procedure to minimize pain. (See Local Anesthetic Agents, Infiltrative Administration.) Typically, lidocaine 1% is used. After the skin is prepared with a povidone-iodine solution or chlorhexidine, make a small wheal with a small (25-gauge) needle in the dermis at the determined entry point for aspiration. Do not inject anesthetic into the joint, because this may hinder synovial fluid analysis.

Alternatively, a topical vapor coolant, such as ethyl chloride, may be sprayed on the skin before needle aspiration. Infrequently, procedural sedation may be required in young children or uncooperative patients.

Positioning

Place the patient sitting upright on a stretcher. Bend the patient’s elbow to 90º. Pronate the patient’s forearm, and rest it with the palm down on a side table set at the appropriate height for comfort.

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