Knee Injections

Indications: Advanced osteoarthritis, noninfectious inflammatory arthritides (gout, pseudogout).

Materials and where to find them:

All supplies can be found in Clean Utility Room (Code 888). For locked drawers/cabinet, use key located in drawer labelled “pens scissors tape” (located above drawer D).

Supply Quantity Where to find
10cc syringe 1 Bins
18g needle (pink) 1 Bins
25g needle (blue) 1 Bins
Chlorhexidine 1-2 Bins
Ethyl chloride spray 1 use key with white dot to open cabinet C
Triamcinolone 10mg/ml 1 vial use key with yellow dot to open drawer with yellow dot
Bupivacaine 0.5% w/o epi 1 vial use key with yellow dot to open drawer with yellow dot
Gauze 1-2 In patient room
Band aid 1 Bins

Knee Injection steps:

  1. Obtain patient consent
  2. Meds: With the 10cc syringe and the 18g needle, draw up 4cc of triamcinolone and 2cc of bupivacaine, gently mix the contents (note, some physicians will inject the anesthetic before the steroid in order to verify injection site).
  3. Remove 18g needle (and dispose in sharps container)
  4. Patient Positioning: Sitting, with legs dangling off of end of examination table
  5. Identify knee landmarks, including patella, patellar tendon, and tibial plateau
  6. Identify injection site: can be medial or lateral (go with whichever side patient has more pain on). Aim to be just inferior to patella, and medial/lateral to the patellar tendon. Mark your site.
  7. Cleanse the injection site with chlorhexidine
  8. Attach the 25g needle to your medication syringe
  9. Spray the injection site with ethyl chloride spray for 5 seconds, then insert the needle, aiming towards posterior knee
  10. When needle is hubbed or near hubbed, slowly inject the 6cc of bupivacaine/triamcinolone.
  11. Remove needle when done, disposing into sharps
  12. Hold pressure with gauze if needed for hemostasis
  13. Apply bandaid

Do the following in Epic:

  • Under med/orders, enter arthrocentesis, major joint (code 20610)
  • If problem focused visit + procedure:
    • Enter normal encounter level (ie “E3)
    • Under modifiers, type “25”
  • If just a procedure visit:
    • Bill as procedure for visit type