II. Indication

  1. Suspected Septic Bursitis
    1. Standard of care recommendation
  2. Suspected inflammatory condition

III. Contraindications

  1. Infection or Skin Ulcer overlying aspiration site

IV. Background

  1. Rising MRSA rate dictates culture-directed therapy

V. 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

VI. 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]

VII. 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

VIII. References

  1. Koutouzis (2006) Marx: Rosen's Emergency Med
  2. Warrington (2024) Crit Dec Emerg Med 38(9): 26

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Bursocentesis (C0392801)

Concepts Therapeutic or Preventive Procedure (T061) , Diagnostic Procedure (T060)
ICD9 83.94
SnomedCT 18694007, 178122004
CPT 20600, 20605, 20610
Italian Aspirazione di borsa
Dutch slijmbeurs aspiratie, aspiratie slijmbeurs
French Aspiration de bourse séreuse, Aspiration d'une bourse séreuse, Ponction de bourse séreuse
German Bursaaspiration, Aspiration Bursa
Spanish Aspiración bursal, aspiración de una bolsa serosa, punción de una bolsa serosa, aspiración de una bolsa serosa (procedimiento), aspiración de bolsa serosa (procedimiento), aspiración de bolsa serosa, aspiración de una bolsa serosa (concepto no activo), bursocentesis, Aspiración de bolsa
Japanese 滑液包吸引, カツエキホウキュウイン
Czech Aspirace burzy
English Aspiration bursa, Bursa aspiration, Aspiration;bursa, Aspiration of bursa, Bursal aspiration, Aspiration of bursa (procedure), Puncture of bursa, Aspiration of bursa (procedure) [Ambiguous], Bursocentesis, aspiration of the bursa
Hungarian Bursalis aspiratio, Bursa aspiratio
Portuguese Aspiração de bolsa sinovial