II. Indication
- Suspected Septic Bursitis
- Standard of care recommendation
- Suspected inflammatory condition
III. Contraindications
- Infection or Skin Ulcer overlying aspiration site
IV. Background
- Rising MRSA rate dictates culture-directed therapy
V. 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
VI. 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]
VII. 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
VIII. References
- Koutouzis (2006) Marx: Rosen's Emergency Med
- Warrington (2024) Crit Dec Emerg Med 38(9): 26