Knee arthrocentesis
The patient’s ___ knee was addressed.
A time out was undertaken to determine that this was the correct patient and the correct procedure for this patient.
Written consent was obtained with appropriate read back of understanding.

The knee was placed and approximately 15° of flexion.
The ___ medial aspect of the knee was prepped and cleansed in the usual sterile fashion. The entry point into the joint space was identified.
After local anesthesia with 1% lidocaine an 18-gauge needle was inserted into the knee joint without complication.

A total of ___ mL of serosanguineous fluid was removed from the knee joint.
5ml of lidocaine mixed with kenalog was then injected through the same access site without removing the needle.
The needle was then removed and a dry sterile dressing was placed.
The patient tolerated this procedure well and there were no complications.

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Procedure
Ankle arthrocentesis
The patient’s ___ lower extremity was addressed.
A time out was undertaken to determine that this was the correct patient and the correct procedure for this patient.
The ankle region was prepped and cleansed the usual sterile fashion.
After local anesthesia with 1% lidocaine, a 20-gauge needle was used to enter the talocrural joint in the standard anterior fashion.
A total of ___ mL of ___ fluid was removed. The needle was then retracted and a dry sterile dressing was placed.
The patient tolerated this procedure well and there were no complications.

• Needle insertion site: between anterior border of the medial malleolus and the tibialis anterior tendon
• Patient positioned with as much plantar-flexion as tolerated
  • http://www.nuemblog.com/blog/ankle-arthrocentesis
    • Dry Taps
      • “If you think you truly are in the joint space, but you aren’t getting any fluid back, consider the “backflow technique”: inject a small amount of saline, and see if you are able to aspirate it back. If so, you are in the right place”
• Disposition
  • Joint aspirate with unlikely septic joint
    • The joint aspirate fluid has ___ white blood cells. Although infection is possible, it is very unlikely given ___ days of symptoms, and a white cell count less than 50,000. However, the patient has been instructed to follow-up with his doctor tomorrow and every 24 hours after that until the symptoms are gone. TFU culture of synovial fluid

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Bursa Aspiration
Olecranon
Pre-procedure: A time out was undertaken to determine that this was the correct patient and the correct procedure for this patient. Patient’s Right Elbow, where the bursal swelling is located, was addressed. The skin was prepped and cleansed in the usual sterile fashion.  The bursal swelling was covered in EMLA anesthetic topical cream for greater than 15 minutes. Placed in flexed position, elbow and forearm rested on surface.
Methods:  Once analgesia was obtained, an 18-gauge needle was used to aspirate 20 cc of bloody fluid until bursa was flat.
Post-procedure: The patient tolerated this procedure well and there were no complications. A dry dressing was placed with a compressive wrap. Distal neurovascular exam remained in tact.

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