Knee Arthrocentesis Periprocedural Care

Updated: Feb 28, 2019
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

Equipment

The materials required for knee arthrocentesis include the following:

  • Sterile gloves and drapes
  • Gauze pads (5), 4 × 4 in.
  • Skin preparatory solution
  • Lidocaine 1%
  • Syringes, 5 mL, 20 mL, 30 mL, 60 mL
  • Needles, 18 or 20 gauge and 25 or 27 gauge
  • Patients who are morbidly obese might require a 21-gauge spinal needle for arthrocentesis
  • Hemostat
  • Specimen tubes
  • Bandage
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Patient Preparation

Anesthesia

Patients who are anxious, in severe pain, or unable to cooperate with the procedure (most commonly children) might require procedural sedation and/or analgesia.

Local anesthesia is always warranted. After skin preparation, draping, and identification of the needle insertion site, use a 25- or 27-gauge needle to inject 2-5 mL of local anesthetic (eg, lidocaine 1%) into the subcutaneous tissue (see the image below). (See Local Anesthetic Agents, Infiltrative Administration.) Deep injections that might enter the joint space are not recommended, because they may alter the synovial fluid analysis results.

Infiltration of local anesthetic via medial parapa Infiltration of local anesthetic via medial parapatellar approach (left knee).

Positioning

After obtaining informed consent, place the patient supine on a gurney. Place a rolled towel below the patient’s knee. A small but randomized study demonstrated that more joint fluid was aspirated from patients in the supine position than from patients in the sitting position. [4]

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