Procedure

Bursa Aspiration

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Bursa Aspiration, Bursocentesis

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