ncm 104 - arthrocentesis

8/2/2019 NCM 104 - ARTHROCENTESIS

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RY AND

DIAGNOSTIC TESTS

(MUSCULO-SKELETAL SYSTEM )

Salimo, Axl Rose P.BS Nursing III


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ASPIRATION & ENDOSCOPIC STUDIES:

The word arthroscopy comes from two

Greek words, "arthro" (joint) and"skopein" (to look). The term literallymeans "to look within the joint."

Is a procedure that allows direct

visualization of a joint to diagnose jointdisorders. Treatment of tears, defects,and disease processes.

May be performed through the

ARTHROSCOPY


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ARTHROSCOPE


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INDICATIONS:

Through the arthroscope, a final diagnosis

is made, which may be more accuratethan through "open" surgery or from X-ray studies.

Disease and injuries can damage bones,cartilage, ligaments, muscles, andtendons. Some of the most frequentconditions found during arthroscopic

examinations of joints are:

InflammationFor example, synovitis is an

inflammation of the lining in the knee,


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Acute or Chronic InjuryShoulder: Rotator cuff tendon

tears, impingement syndrome, andrecurrent dislocationsKnee: Meniscal (cartilage) tears,

chondromalacia (wearing or injuryof cartilage cushion), and anteriorcruciate ligament tears withinstabilityWrist: Carpal tunnel syndromeLoose bodies of bone and/orcartilage: for example, knee,

shoulder, elbow, ankle, or wrist


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HOW IT IS PERFORMED?

Operating Room under sterileconditions.

Injection of a local anesthetic into the

joint or general anesthesia.A small incision (about the size of a

buttonhole) will be made to insert the

arthroscope. With development of better

instrumentation and surgical

techniques, many conditions can betreated arthrosco icall .


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oThe puncture wound is closed withadhesive strips or suture and covered

with a sterile dressing.

oComplications are rare but may

include infection, hemarthrosis,stiffness, adhesion, delayed woundhealing, effusion.


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NURSING INTERVENTIONS

The joint is wrapped with a compression dressingto control swelling.

Ice may be applied to control edema anddiscomfort.

The joint is kept extended and elevated to reduceswelling.

Explain when to resume activity and what weight-bearing limits to follow, as prescribed by the

orthopedic surgeon. Explain possible signs as signs of complications

that should be immediately reported to thephysician (swelling, numbness, cool skin).

Explain physicians prescription for analgesicmedication.


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ASPIRATION & ENDOSCOPIC STUDIES:

Is a procedure carried out to obtain

synovial fluid for purposes ofexamination or to relieve pain toeffusion.

Examination of synovial fluid is helpful in

the diagnosis of septic arthritis and otherinflammatory arthropathies reveals thepresence of hemarthrosis, which

suggests trauma or bleeding disorders.

ARTHROCENTESIS


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ARTHROCENTESIS


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HOW IT IS PERFORMED?

The skin over the joint is sterilized using aliquid, typically iodine solution (Betadine).

Local anesthetic is used in the area of thejoint; either by injection, topical liquid

freezing, or both. A needle with a syringe attached is

inserted within the joint an fluid is suckedback (aspirated) into the syringe.

For certain conditions, the doctor will alsoinject medication into the joint after fluidremoval.

The needle is then removed and a Band-


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SYNOVIAL FLUID ANALYSIS

Physical testsStraw coloredClearModerately viscous drops of it from a

syringe needle will form a string a few

inches long.Changes in the physical characteristics may

provide clues to the disease present suchas:

Less viscous fluid may be seen withinflammation.Cloudy synovial fluid may indicate the

presence of microorganisms, white bloodcells, or crystals.

Reddish synovial fluid may indicate the


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Chemical tests tests that may beperformed on synovial fluid samples may

include:Glucosetypically a bit lower than blood

glucose levels. May be significantly lower

with joint inflammation and infection.Proteinincreased with bacterial

infection.

Lactate dehydrogenaseincreased LD

(LDH) level may be seen in rheumatoidarthritis, infectious arthritis, or gout.

Uric acidincreased with gout


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Possible complications include local bruising,minor bleeding into the joint, and loss of

pigment in the skin that was entered by theneedle. A rare but serious complication of

joint aspiration is infection of the joint (septicarthritis).


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REFERENCES

Smeltzer S. C. et al (2008) Brunner and SuddarthsTextbook of Medical Surgical Nursing EleventhEdition. Philadelphia Lippincott Williams and WilkinsChapter 66 pages 2350, 2351

Shiel W. C. (2008) Joint aspiration

Online article retrieved from www.MedicineNet.com

(01/11/12, 1132H)

ncm 104 - arthrocentesis

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