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