Ultrasound guided tap of hip effusion

  • 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