INJECTIONS AND ASPIRATIONS PERFORMED ON ELLISON 2 (FLUORO/CT) or WHITE 2 (ULTRASOUND)

Occasionally you will do Fluoroscopically/Ultrasound-guided aspirations or CT-guided injections (epidural steroid injections, thoracic nerve root blocks, steroid for eosinophilic granuloma, sclerosing agent for vascular lesions or aneurysmal bone cysts, Botox for piriformis), and you will need to bring ALL your medications with you from Yawkey 6 (steroids, Botox) or order it separately (Calcitonin). 

To schedule these, approve in Epic and talk to Michelle about finding a resource (fluoro or ultrasound room) for the procedure

You will need:

FLUORO ASPIRATIONS (Inpatient usually Ellison 2 GI or Pedi fluoro rooms)

• Discogram (basic fluoro procs) tray

• 3.5. inch 20 or 18 gauge needle

• Lidocaine

• Iodinated contrast (Isovue)

• One 5 mL slip tip syringe (for lidocaine)

• One 3 mL slip tip syringe (for contrast)

• Two 10 mL luerlock syringes (see the tip!)

• Deadhead

• Purple top tube

• Just to be safe: sterile gloves, skin marker, micro bag (for culture sample), path bag (for cell count sample), chlorhexidine

ULTRASOUND ASPIRATIONS (Inpatient usually White 2 ultrasound rooms)

• Ultrasound procs tray

• Probe cover

• Chlorhexidine

• 3.5. inch 20 gauge needle

• Lidocaine

• Iodinated contrast (Isovue)

• One 5 mL slip tip syringe (for lidocaine)

• Two 10 mL luerlock syringes (see the tip!)

• Deadhead

• Purple top tube

• Just to be safe: sterile gloves, skin marker, micro bag (for culture sample), path bag (for cell count sample)

COLLECTING THE SAMPLES:

a. Purple top (EDTA) tube contains inhibitors/anticoagulants, use only for cell counts and joint crystals; you can send the culture in the syringe (expel air, add dead head).

b. For aspirations, if you get pus, you're done. Send the sample for micro and cell count. If you don't get an aspirate or the aspirate isn't clearly pus, please try to core the synovium using the 20 gauge needle.

• • • For now, these will need SEPARATE orders in Epic (yes, 2 sets - sorry i know, a pain)

    • If you are unsure how to core the synovium or to send samples, please ask Connie. 

c. Crystal arthropathy aspirates can look EXACTLY like pus. Have a high index of suspicion and send crystals if there is any question (>1 mL in syringe with dead head)

d. Sacroiliac joint sampling is done preferably under CT