關節液抽吸(Arthrocentesis)

2024/02/11閱讀時間約 2 分鐘

Indication

  1. 區分關節炎的種類(infective? crystalline?)
  2. 給予特定治療(關節腔注射),ex. 葡萄糖水、玻尿酸、PRP

Contraindication

Absolute:

  • Puncture site cellulitis or other infection

Relative:

  • Coagulopathy(little harm)
  • Bacteremia?

Procedure

  1. 先用echo掃描關節腔周圍四個象限+觸診,尋找關節液最多的地方,用棉棒末端定位(定位點再用兩個超音波平面確認入針處液體足夠)
  2. 無菌消毒*3,至少整個關節完成消毒
  3. 戴無菌手套、鋪設無菌洞巾
  4. 準備好抽吸針(18-22gauge),針筒,確認定位後跟病人說明並且垂直入針
  5. 保持負壓進針直到抽到關節液,大約抽到20-40cc即可
  6. 用紗布將入針處蓋起來並加壓5-10分鐘
  7. 告知觀察是否有後續局部紅腫熱痛
    (可局部麻醉不過病人須多挨一針)

Complication

  1. 感染(Infection)
  2. 出血(Bleeding)
  3. 過敏(Allergy),主要是對關節內注射藥物過敏

Synovial fluid analysis

    1. 外觀(General appearance):
      1)質地:透明、混濁
      2)顏色:清澈、黃、紅
    usmlepathslides:
“ Synovial fluid tubes:
From left to right,
•  normal
• noninflammatory (e.g., osteoarthritis)
• inflammatory (e.g., rheumatoid arthritis)
• septic (e.g., gonococcal septic arthritis)
•  hemorrhage (e.g., trauma, hemophilia A)
”

    usmlepathslides: “ Synovial fluid tubes: From left to right, • normal • noninflammatory (e.g., osteoarthritis) • inflammatory (e.g., rheumatoid arthritis) • septic (e.g., gonococcal septic arthritis) • hemorrhage (e.g., trauma, hemophilia A) ”

    1. 關節液常規檢查(Joint fluid routine)
      1) WBC
      #Normal:<200
      #Non inflammatory: 200-2000
      #Inflammatory:2000-50000
      #Septic:>50000
      2) Neutrophil count
      3) Gram stain
      4) Crystal
      #Gout: needle shape and negative birefringent
      #Pseudogout(calcium pyrophosphate deposit): rhomboid and positive birefringent



      illustration
      贊助支持創作者,成為他繼續創作的動力吧!
      0會員
      1內容數
      留言0
      查看全部
      發表第一個留言支持創作者!
      從 Google News 追蹤更多 vocus 的最新精選內容