- Patient preparation: orthopedic exam, CBC, ESR, ultrasound of the hip to document the effusion, obtain informed consent, sedation per clinical service
- Contrast used: none
- Technique:
— Sterile prep and drape, place sterile cover on transducer
— Using real-time ultrasound guidance, insert a 20 gauge 3 1/2″ long spinal needle into the joint capsule and aspirate the fluid. An 18 gauge or 22 gauge spinal needle can also be used
— As you insert the needle, twist it 360 degrees to ensure you puncture the joint capsule
— Give sample to clinical team - Images to obtain: sagittal images of femoral head and proximal femur with needle in fluid
- Looking for: needle in fluid in the anterior recess of the femur
- Post procedure tasks: if the fluid is turbid and has a WBC count greater than 20,000 or if the gram stain is positive the patient needs immediate open surgical drainage
Pediatric Imaging 