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Arthrocentesis 1059

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A B C

Procedures and Techniques

D E
ARTERIAL BLOOD SAMPLING AND ARTERIAL CATHETERIZATION Placement of arterial catheter in a dog’s
right metatarsal artery. A, Palpation of arterial pulse. B, Introduction of catheter using right hand while simultaneously
palpating arterial pulse for orientation using left hand (i.e., right-handed clinician). C, Flashback of blood confirms
proper placement. D, Removal of stylet in preparation for placement of catheter cap. E, Capped catheter is flushed
with heparinized saline, wrapped, and clearly marked as arterial.

• Insert IVC through the skin incision and into • Ensure the catheter is not dislodged, or • Surgical cut-down procedure for arterial
the artery at a 15-30–degree angle running significant bleeding may ensue. catheter placement
parallel to the anatomic course (some prefer • Flush catheter after all blood draws; ○ More invasive
to keep the bevel of the needle pointing thrombosis/occlusion can occur.
down for arterial puncture). • Label catheter clearly as arterial to prevent SUGGESTED READING
• When flashback or pulsatile flow (with open inadvertent injection of medications into Trim CM, et al: A survey of the use of arterial
catheter) is seen, advance the catheter off the the catheter, which could have dangerous catheters in anesthetized dogs and cats: 267 cases.
needle. complications. J Vet Emerg Crit Care 27:89-95, 2017.
• Attach T-port and 3-way stopcock with male AUTHOR: Lillian Good, DVM, DACVECC
adapter. Alternatives and Their EDITORS: Leah A. Cohn, DVM, PhD, DACVIM;
• Flush with heparinized saline. Relative Merits Mark S. Thompson, DVM, DABVP
• Anchor to patient’s leg using white tape. • Venous blood gas analysis
Clearly mark catheter and line as arterial. ○ Technically easier to perform
○ PvO 2 less relevant
Postprocedure • Pulse oximetry
• Monitor for bleeding, inflammation, ○ Noninvasive
infection ○ Not always reliable

Arthrocentesis

Indications Equipment, Anesthesia
Difficulty level: ♦♦
• Swollen joints (effusion) • Sedation usually required
Synonyms • Painful joints unexplained by recognized • Clippers
Joint aspirate, joint tap, synovial tap orthopedic disease • Gauze, alcohol and surgical scrub
• Stiff, stilted gait suggestive of polyarthritis • Microscope slides and #2 pencil for
Overview and Goal (p. 803) labeling
A procedure to obtain a small amount of • Fever of unknown origin (p. 334) • 22-25 gauge needles (preferably plastic hub),
synovial (joint) fluid for diagnostic purposes, at least one per joint
usually including cytologic evaluation ± bacte- Contraindications • 1-6 mL syringes, several
rial culture Wound or pyoderma over the aspiration site; • Sterile gloves
severe thrombocytopenia or coagulopathy

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