Aspiration of joints during therapeutic injections

[Timeoutofmind]

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When injecting a knee/hip/shoulder...
Do you routinely attempt to aspirate before injecting? Not just a small amount of synovial fluid to confirm placement, but to aspirate a larger amount of fluid therapeutically? How much? As much as you can? Is there any harm in decreasing the amount of synovial fluid in a joint in this way?

In my fellowship, we really didnt. Just injected. But seems a lot of people do? As in "I took 40cc out of that guys hip" etc

Thanks in advance.

 

[lobelsteve]

Yes, if effusion present drain as much as you can before injecting therapeutic agents.

 

[Ducttape]

No harm, drain as much as possible, and may provide some temporary pain reduction in and of itself.


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[DODOCSS]

also helps diagnostically if heme

 

[Timeoutofmind]

Yes, if effusion present drain as much as you can before injecting therapeutic agents.

Cool thanks.
If hemarthrosis...what do u do though? Investigate for coagulapathy? Advanced imaging?
Even trauma or OA can cause hemarthrosis so it seems pretty nonspecific.

 

[mazinger]

Yes, if effusion present drain as much as you can before injecting therapeutic agents.

How do you bill for it?
20611 x2?

 

[lobelsteve]

Cool thanks.
If hemarthrosis...what do u do though? Investigate for coagulapathy? Advanced imaging?
Even trauma or OA can cause hemarthrosis so it seems pretty nonspecific.

Never saw one. If i did, the hx and med list should cover it, then off to ortho.

 

[lobelsteve]

How do you bill for it?
20611 x2?

20610 per joint. The effusion was not why i was seeing them.

 

[DOctorJay]

20611 if using ultrasound, bill once

I took 90 cc of fluid out of some lady's shoulder last week


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[Timeoutofmind]

20611 if using ultrasound, bill once

I took 90 cc of fluid out of some lady's shoulder last week


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The shoulder capsule can fit 90cc?!?!

 

[DOctorJay]

This lady's shoulder looked like there was a balloon in it. Trashed joint from RA and years of relying on arms instead of legs. In a power chair now. She felt so much better after the aspiration.


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[Tapspatellas]

What gauge needles is everyone using to aspirate? I find with anything smaller than a 21 or 22 gauge I don't tend to get too much out. If using a smaller gauge, any tricks?

 

[Taus]

What gauge needles is everyone using to aspirate? I find with anything smaller than a 21 or 22 gauge I don't tend to get too much out. If using a smaller gauge, any tricks?

18


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[lobelsteve]

22G, I can use a 25g but it takes forever.

 

[Gauss]

Cool thanks.
If hemarthrosis...what do u do though? Investigate for coagulapathy? Advanced imaging?
Even trauma or OA can cause hemarthrosis so it seems pretty nonspecific.

Some heme is not unusual with any aspiration due to the trauma, however if it's dark red frank blood you've got a different Dx - ligament rupture, fracture, PVNS, etc

 

[emd123]

I aspirate if there's any suspicion of effusion, before steroid injection. They always feed better immediately, if able to get significant fluid out. My record is 60cc in a knee. The knee was huge. Chronic recurrent effusion.


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