Healthcare and Medicine Reference
In-Depth Information
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Figure 21.5 Step-by-step guide: suturing. (a) Initial insertion of needle
(with eversion of distal wound edge). (b) Insertion of needle through
proximal wound edge. (c) Position of suture - length of 3-5 cm on distal
edge. (d) Two clockwise turns of suture over needle holder. (e) Grasping the
short end of suture with needle holder. (f) Forming the fi rst knot.
(g) Securing knot with anticlockwise turn of suture over needle holder.
(h) Securing the knot.
Joint aspiration/arthrocentesis
Bleeding/haematoma formation.
Introduction
Joint aspiration (arthrocentesis) is a procedure of therapeutic and
diagnostic importance for joint swellings. It must be performed in
a competent, safe manner as it can potentially introduce infection
into a previously sterile joint space.
Inversion/overlapping of wound edges.
'Dog-earing' - this is where there is a unilateral excess of wound
edge left over, caused by poorly placed sutures. If this occurs take
your sutures out and start again.
Late
Infection/abscess formation.
Indications for joint aspiration
Therapeutic indications
Drainage of a tense haemarthrosis <24 hours old.
Bleeding (secondary haemorrhage).
Wound breakdown.
Drainage of a tense joint effusion for pain relief.
Skin necrosis.
Diagnostic indications
Evaluation of an unexplained arthritis with associated effusion.
Suture displacement.
Non-healing wound.
Scarring.
Clinical suspicion of a septic joint/crystal arthropathy.
Loss of function.
Evaluation of antibiotic sensitivities to a suspected septic joint.
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