• Do not make an ink mark directly over injection/aspiration
site because it will enter the joint when the needle passes through
• Instead, use the wood end of a sterile cotton swab or another
round object to make an indentation in the skin prior to cleaning
• If infection is a concern, a larger bore needle (18 gauge or 19
gauge) may be needed to aspirate because sometimes purulent fluid
will not be drawn into a smaller needle.
• Do not overtighten the needle on to the syringe, and check to
make sure the needle easily twists off the syringe before starting
• This allows you to empty a full syringe and reattach it without
ever pulling the needle out of the joint.
• Lidocaine can be used to numb the skin prior to aspiration/injection,
but it can distort anatomic landmarks.
• Alternatively, a topical agent such as ethyl chloride can be used.