Once the procedure is complete, the antiseptic should be cleaned off the skin, site dried, and pressure and a soft dressing applied for local hemostasis. The syringe may be emptied and reattached to the indwelling needle repeatedly, minimizing needle entry points. The fluid should then be transferred to a sterile specimen collection cup and sealed for transport to the laboratory for analysis. On obtaining access to the joint, negative pressure should be maintained in the syringe until an adequate amount of synovial fluid is collected. A spinal needle may be an option for deeper joints or patients with anatomy complicated by obesity.
Next, a large gauge, sharp needle, typically 18 gauge (or smaller if a smaller joint in being aspirated), is inserted into the joint attached to a minimum 10 cc syringe. Local anesthetic can be used to create a cutaneous/subcutaneous wheel for local pain control. The site is then prepped and draped in the usual sterile fashion using antiseptics that include one or a combination of alcohol, betadine, and/or chlorhexidine. The literature documents the safe entry portals thoroughly for the shoulder, elbow, wrist, hip, knee, and ankle. Once indications are met for arthrocentesis, aspiration site is selected and marked. Fluoroscopy and CT guided arthrocentesis can also provide utility for deeper joints including shoulder and hip.
Ultrasound technology may be useful in ensuring correct needle placement but is often unnecessary. Sterility is essential not only to prevent transmission of infection but also to ensure accurate fluid analysis. This procedure should be done under sterile procedural conditions and performed by a physician with intimate knowledge of the involved anatomy. Arthrocentesis is the process by which synovial fluid collection occurs by penetrating the joint space through aspiration.
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