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ARTHROCENTESIS I.

DEFINE RELATED TERMS: 1.) Bursae >is a small fluid-filled sac lined by synovial membrane with an inner capillary layer Of slimy fluid (similar in consistency to that of a raw egg white). It provides a cushion between bones and tendons and/ or muscles around a joint. This helps to reduce friction between the bones and allows free movement. Bursae are filled with synovial fluid and are found around most major joints of the body. 2.) Synovial Fluid >acts as a shock absorber and a lubricant, allowing the joint to move freely >a clear, viscous fluid that lubricate the lining of joints and the sheaths of the tendons, contain mucin, albumin, fat, mineral and mineral salts. 3.) Synovial Joints > also known as a diarthrosis > is the most common and most movable type of joint in the body > is characterized by the presence of a layer of fibrocartilage or hyaline cartilage that lines the opposing bony surfaces, as well as a lubricating synovial fluid within the synovial cavity. 4.) Arthritis >inflammation of a joint >is a group of conditions involving damage to the joints of the body. 5.) Arthrocentesis >is the clinical procedure of using a syringe to collect synovial fluid from a joint capsule. It is also known as joint aspiration. Arthrocentesis is used in the diagnosis of gout, arthritis, and synovial infections. 6.) Bursitis >is the inflammation of one or more bursae (small sacs) of synovial fluid in the body 7.) Synovitis >inflammation of the synovial membranes of a joint as a result of an aseptic wound, traumatic injury. 8.) Syndesmoses >an immobile joint in which the bones are held firmly by fibrous tissue. 9.) Osteoarthritis >a form of arthritis associated with bone and cartilage degeneration. 10.) Crystal-Induced Arthritis > Gouty Arthritis >a systemic disease in which urates crystals deposit in joints and other body tissue II. ANATOMY AND PHYSIOLOGY OF SYNOVIAL JOINTS: a.) Joints

>any union between adjacent bones, whether or not movement of the bones relative to another is possible. b.) Fibrous Joints >the bones are held together only by ligaments a type of fibrous connective tissue. c.) Cartilaginous Joints >are those in which the bones are attached to each other by cartilage, a different and special type of connective tissue. d.) Synovial Joints >the ends of bones are covered by cartilage, but there is space, in the joint cavity between them. The entire area is enclosed by a capsule made up of a tough, fibrous outer layer and a thinner more delicate inner layer known as the synovial membrane. *4 Distinguishing Features* 1.) Articular cartilage >covers the ends of the bones forming the joints. 2.) Fibrous Articular Capsule >the joint surfaces are enclosed by a sleeve or capsule of fibrous connective tissue and the capsule are lined with a smooth synovial membrane. 3.) Joint Cavity >the articular capsule encloses a cavity called the joint cavity which contains lubricating synovial fluid. 4.) Reinforcing Ligament >the fibrous capsule is usually reinforced with ligaments. e.) Capsule >made of tough membrane encloses the joint and connects one bone to shoulder holding them firmly in place. f.) Synovium >is the inner lining of the capsule with secretes synovial fluid to lubricate and nourish the cartilage. g.) Ligaments >attach the bone to bone and help to provide stability h.) Tendons >attach muscle to bone, allowing for movement and acting as secondary joint stabilizer i.) Muscles >contract to provide the force for movement and are critical for much of the shock absorptions around the joint. III. IMPORTANCE OF ARTHROCENTESIS: -To obtain samples of synovial fluid for

diagnostic purposes -To remove fluid from the joint to relieve pain -Use to instill medication into the spinal cavity -To understand the different signs and symptoms manifested -To confirm tentative diagnosis IV. A.) INDICATIONS: 1.) Patient with Joint Effusion >is an increase in fluid within the joint space. The increase in joint fluid often leads to a Distention of the joint capsule and s swelling of the joint. 2.) Patient with Hemarthrosis >bleeding into a joint is referred to as hemarthrosis and is an important cause of monoarticular joint pain and swelling. 3.) Patient with suspected arthritis

>introducing an infection into a previously sterile joint is the major complication of arthrocentesis. The overall rest of infection is approximately 1-2 infection per 25,000 arthrocentesis performed, and staphylococcus aureus is the most common causative organism. Risk factors include inattention to sterile technique, introduction of a needle through an area of infection, or presence of a systemic infection. 2.) Trauma >tendon injury or rupture, and nerve or blood vessel damage secondary to improper needle placement have been reported. 3.) Pain >patients often complain of pain during the procedure. This is often a result of the needle contacting the highly innervated cartilaginous surfaces of the joint. The physician should pull back or redirect the needle if this occurs. 4.) Reaccumulation of effusion >this may be seen after the aspiration of any joint. Placing an elastic wrap around the joint Immediately after the procedure may restrict further fluid accumulation. 5.) Joint Instability >repeated steroid injections subsequently develop joint instability secondary to osteonecrosis of adjacent bone and weakening of capsular ligaments. Consequently, injections should not be performed more than once every 6 to 8 weeks and no more than three times per year in weight-bearing joint. VII. NURSING RESPONSIBILITIES: Before: >check the doctors order >monitor vital signs >teach patient with proper positioning >inform the patient about the nature of the procedure During: >position the patient comfortably with adequate support >reassure to support patient during the procedure >expose the area and provide privacy >fill and arrange specimen bottle accordingly >label each specimen bottle accordingly and send immediately to laboratory After: >advice the patient that he or she will

B.) CONTRAINDICATIONS: 1.) 2.) 3.) 4.) 5.) Overlying infection in the soft tissues Abscess and cellulitis Severe overlying dermatitis Bacteremia Uncooperative patient

V. PRINCIPLES INVOLVE IN ARTHROCENTESIS: 1.) Anatomy and Physiology >is involved to properly locate site of arthrocentesis >to know the right anatomical site for arthrocentesis 2.) Microbiology >use of sterile technique to maintain sterility and to prevent sepsis >to eliminate microorganisms and exacerbate the condition of the patient 3.) Time and Energy >prepare the needed materials o conserve time and energy 4.) Psychology >explaining the procedure to the patient, giving all the information about the procedure Reduces anxiety and enhances cooperation 5.) Body Mechanics >proper body posture can prevent strain and muscle spasm in the part of the nurse

VI. COMPLICATIONS INCLUDE: 1.) Infection

be bed rest and an x-ray will be obtained >record the total amount of the fluid withdrawn from the procedure >monitor vital signs and watch closely for any complications VIII. MATERIALS NEEDED: >needle gauge #18 >(3) specimen bottle >syringe 10 cc, 3 cc >betadine >4x4 OS >cotton balls >plaster >lapsheet >sterile gloves >lidocaine IX. GUIDELINES IN ARTHROCENTESIS Assess patients allergy to local anesthesia to be used Administer sedation if prescribed Make sure that the patient maintains the proper position throughout the procedure Ascertain that x-ray has been completed and consent from patient has been signed prior to procedure Refrain patient from moving the joints 24 hours after the procedure Apply pressure dressing for 2-3 minutes after the procedure