Septic Arthritis Clinical Pathway — Emergency Department
MD/CRNP/RN Assessment, Bedside Procedures
General
- Notify MD if concerned about patient’s appearance
- Reinforce NPO status
- Assess need for analgesia
- Assess hydration status, need for IV placement, lab studies, radiographs
- Apply LMX-4 immediately:
- For IV placement as per protocol
- To medial, lateral surfaces of the knee if applicable
IV and Laboratory Studies
- Place IV
- For patients triaged as Level 1, 2 send:
- CBC
- CRP
- ESR
- From synovial fluid
- Bacterial culture and Gram stain
- Cell counts and differential
- Kingella testing by PCR if ≤ 5 years
- Discuss with MD/CRNP:
- Blood culture
- Lyme testing: Serum IgM and IgG
IV Fluids
- Assess need for IV hydration
Preparation for Joint Aspiration
- Prepare family and patient as needed for sedation analgesia
- Place the following at the bedside:
- One each 16 gauge, 18 gauge, and 25 gauge needle
- Two 20 ml syringes and one 10 ml syringe
- 1% Lidocaine with epinephrine
- Three packets of sterile drapes
- One sterile urine cup
- Sterile gloves
Synovial Fluid Studies (use ED Order Set)
- Gram Stain
- Cell Count
- Culture
SEND SYNOVIAL FLUID SPECIMENS IN A LABELED STERILE URINE CUP
DO NOT use a blood culture bottle, syringe, or sterile tube