Steps for combined intra-articular aspiration and injection

1. Determine indication for procedure.

2. Obtain informed consent; discuss risks, benefits, and alternatives with the patient.

3. Prepare equipment, including laboratory requests, needles, syringes, and medication.

4. Identify and mark the appropriate anatomic landmarks to guide needle placement.

5. Clean overlying skin using isopropyl alcohol (povidone iodine [Betadine] also can be used).

6. Use cooling spray or local anesthetic for patient comfort (as needed).

7. Select appropriate length and gauge of needle; judiciously guide needle into intra-articular space.

8. Gently aspirate fluid (procedure should not be painful).

9. Anchor needle with hemostat to prevent migration from the intra-articular space.

10. Remove aspirant syringe and replace with syringe Containing steroid and/or anesthetic for injection.

11. Inject medication into the intra-articular space (fluid should move freely into the joint space); if resistance is met, try rotating or repositioning syringe to ensure that the needle is still in the correct space.

12. Remove needle and apply bandage.

13. Provide post-procedural counseling.