MSK Aspirations / Spine Procedures

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MSK Aspirations/Spine Workflow

Large Joint Aspirations (Hip, Knee, Shoulder):

  1. Community Radiologist to cover.
  2. If after hours/weekend, can contact ordering provider to see if it can be performed the next day.
  3. If the procedure can be performed the next day, have provider place an order.
  4. If it cannot be postponed, contact the fluoro tech and nurse on call and schedule.
  5. Use large bore needle (20 or 18g) and aspirate fluid- may be asked to inject preservative free saline into the joint and recollect the fluid for cell count/culture.

Other Joints/Spine:

  1. If daytime hours, see if there is a Community Radiologist or IR Radiologist capable and able to do the procedure (Community MSK Radiologists, IR etc.). If there is, have ordering physician contact them directly to coordinate case.
  2. If after hours or the weekend, contact ordering physician and check to see if case can be postponed until a Community Radiologist or IR Radiologist would be available (If there will be someone to do the procedure on the next day). If not or no one would be available, go to 3.
  3. Have ordering provider to contact UW MSK attending on call to see if procedure is indicated and whether they would be willing to do the case at UW. Ordering provider would arrange transfer.

Examples:

  1. Elbow aspiration is requested Wednesday night at 9pm. Comm MSK Radiologist will be at 1 SP the next day. Ordering physician is called who is okay with having it done the next day. Contact the Community MSK Radiologist to inform them of the pending case at Meriter (text or call them in the evening or in the morning).
  2. Ankle aspiration is requested Saturday at 9am (or weekday after hours). Clinician insists on emergent aspiration. Have ordering clinician contact UW MSK attending on call to see if they would do the case emergently at UWH.
  3. L2-3 Disc aspiration is requested at 4pm on Tuesday. IR doc at Meriter that day has never done a spine procedure. Have ordering clinician contact UW MSK attending on call to see if they would do the case at UWH.
  4. Knee aspiration requested at 11pm. On call Community Radiologist should call ordering physician to see if aspiration can be done first thing in the morning. If it cannot be postponed,call fluoro tech and arrange case.