Knee Joint Aspiration and Injection - October 1, 2002

Procedure Recording Form

Knee Joint Aspiration and Injection

Patient name: ______________________________ Date: __________ Age: ______

Affected joint: _________________________________________________________

Circle all that apply:

Joint pain?	Yes	No	Bacteremia?	Yes	No
Joint effusion?	Yes	No	Coagulopathy?	Yes	No
Joint prosthesis?	Yes	No	Joint trauma?	Yes	No
Overlying redness?	Yes	No	Overlying dermatitis?	Yes	No
Fever or chills?	Yes	No	Prior gout?	Yes	No

Length of time symptoms have been present: _________________________________________________________

Radiographic findings of the joint: _________________________________________________________

Pertinent history: _________________________________________________________

Procedure description:

The skin was prepped with povidone-iodine solution. The joint was entered from the _________________ approach using a 21-gauge or ___________ needle. Fluid was obtained for studies. Corticosteroid injection was performed using ______________.

Gram stain	Acid-fast bacillus and tuberculosis culture
Culture and sensitivity	Glucose, protein, lactic acid dehydrogenase
Complete blood cell count and differential	Viscosity
Crystal analysis	Other: _____________________
Color of the fluid

Complications: _________________________________________________________

Impression: _________________________________________________________

Plan:
______	Studies as above
______	Postprocedure instruction sheet given to patient.

Physician: ____________________________ CC: ____________________________

Adapted with permission from Zuber TJ. Office procedures. Baltimore: Lippincott Williams & Wilkins, 1999.

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