Procedure
Bursa Aspiration
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Bursa Aspiration
, Bursocentesis
See Also
Septic Bursitis
Acute Olecranon Bursitis
Prepatellar Bursitis
Indication
Suspected
Septic Bursitis
Standard of care recommendation
Suspected inflammatory condition
Contraindications
Infection or
Skin Ulcer
overlying aspiration site
Background
Rising
MRSA
rate dictates culture-directed therapy
Technique
Consider
Ultrasound
guidance to localize largest fluid pocket
Aseptic technique with overlying skin antiseptic preparation (e.g.
Chlorhexidine
)
Consider Z-Track needle insertion (may prevent fistula formation)
Needle: 18-20 gauge
Needle approach from lateral or distal aspect
Aspirate adequate fluid for analysis
Additional fluid removal may also decrease patient's pain
However fluid often reaccumulates
Apply bandage and elastic compression wrap
Complications
Benefit of aspirate findings may outweigh risk in suspected
Septic Bursitis
Draining sinus or fistula development: 6%
Sinuses develop at site other than aspiration site
Implies that sinuses were unrelated to aspiration
Stell (1999) J R Soc Med 92:516 [PubMed]
Labs
Aspirated Fluid
Bursal fluid culture
Bursal fluid
Gram Stain
Bursal fluid crystal analysis
Bursal fluid cell count with differential
WBC >2000 cells/mm3 suggest septic bursa
WBC <1500 cells/mm3 suggest non-infected bursa
References
Koutouzis (2006) Marx: Rosen's Emergency Med
Warrington (2024) Crit Dec Emerg Med 38(9): 26
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