Key Considerations for Safe and Effective Injection and Aspiration Procedures

Indication for Treatment
Injections and aspirations are used for various conditions. Recent practices have expanded injections for degenerative spinal diseases and other uses like neurotoxins and fillers. WHO guidelines on injection practices have been considered. In orthopedics, intra-articular injections in knee and shoulder joints are common for therapeutic or diagnostic purposes. Other uses include aspiration of cysts or abscesses for diagnostic or treatment purposes .

Settings
Preparation for injections or aspirations begins with determining the treatment’s indication and ensuring an appropriate environment. Patients are often sensitive to vasovagal fainting, risking falls and injuries. It’s crucial to inform patients about the procedure and potential side effects. Ensuring the patient is in a stable, supported position, preferably lying on their back, is essential. The healthcare provider must also be well-prepared, with good access to the area of interest in a suitable environment .

Medical History
Patients should be evaluated for prior health issues, infection risks, and medications before treatment. For patients on anticoagulation therapy, the benefits must outweigh the bleeding risks. According to Kotecha et al., bleeding complications in patients on anticoagulants are rare. A thorough evaluation of previous allergic reactions to vaccinations or injections is necessary before proceeding .

Ultrasound-guided techniques can be a supplementary option for more accurate penetration, especially in patients with challenging anatomy or where manual palpation is difficult. Ultrasound-guided aspiration is particularly valuable for suspected arthroplasty infections, offering greater accuracy than conventional methods .

Anatomical Landmarks
Healthcare providers must know local anatomical landmarks like osseous points, which should be palpated and marked accordingly. Marking the injection site is crucial but often disappears with skin cleaning. It’s recommended to create a lasting indentation using an instrument like a pen cap .

Minimize Risk of Infection
Careful preparation of the injection site is vital, focusing on signs of redness, swelling, or other skin changes. Elective procedures should be postponed if skin damage is present to reduce infection risk. In acute settings, the decision to proceed must balance the need for immediate treatment against potential adverse effects .

The Procedure
Start by cleaning the skin and applying local anesthesia, waiting 10-15 minutes for numbing. Inject the needle perpendicularly through the skin before adjusting to the target area. Use a sterile method, especially when penetrating joints, to reduce infection risk. Know the local anatomy to avoid damaging neuromuscular structures. For example, injecting corticosteroids into subcutaneous fat can cause skin necrosis.

Perform negative aspiration to avoid intravenous injection. Inject steadily without causing pain. If resistance is felt, ensure the needle is within the joint. Resistance may indicate the needle is in muscle, tendon, bone, or cartilage. If sharp pain occurs, it might be due to injection into the synovia, requiring needle adjustment .

Conclusion
Injections and aspirations are valuable in many healthcare areas. Providers must evaluate treatment indications and ensure the benefits outweigh the risks. Thorough medical history review, proper area marking, sterile environment, and anatomical knowledge are critical. Ultrasound-guided techniques can improve accuracy in complex cases. Proper injection technique, including negative aspiration and careful needle placement, helps avoid complications. Post-procedure, apply pressure to control hemostasis before allowing the patient to leave .