Aspiration of Haemarthrosis (Elbow)

The elbow of a 78-year-old woman became swollen and painful within an hour - a typical history of haemarthrosis. Warfarin treatment with a high INR (3.9) was the predisposing factor. Ultrasonography shows a large, compressible collection in the joint cavity, suggesting blood in the joint. Such an ultrasound finding may also be caused by thick pus. The injection location is palpated and marked on the skin, after which the skin is cleansed. Use sterile gloves and perform the procedure in as sterile manner as possible to minimize the risk of contamination of the sample taken for bacterial culture (blood may also be a sign of a bacterial infection).

The skin is anaesthetized with lidocaine. A large needle is used to facilitate aspiration. If blood is found in aspiration, always try to empty the joint of excess blood. Removing the blood alleviates pain and hastens the recovery of function. In such a situation, no glucocorticoid is injected, since haemarthrosis may also be caused by bacteria. The injection site is covered with self-adhesive sterile dressing and the joint should be kept at rest until the bleeding subsides. The injection site should be kept dry until the next day. The most common site for a haemarthrosis is the knee, followed by the ankle.

Aspiration of Haemarthrosis (Elbow)