Adult Rheumatology — Core of Discipline

C3a Performing and interpreting the results of joint, bursa and tendon aspirations and/or injections - Part A: Aspiration/Injection

Key Features:
- This EPA includes all of the following: knowledge of the indications and contraindications; informed consent; preparation; aseptic technique; performance; sample handling and sending fluid for appropriate analysis; and post-procedural care including documentation and managing any immediate complications.
- This EPA does not include knees, which were previously assessed in Foundations, nor the spine, sacroiliac joint (SI) joints, hips, nor temporomandibular joints (TMJ)
- The use of ultrasound is not an expectation of this EPA, and a dry aspirate is acceptable.
- This EPA includes crystal analysis.
- The observation of this EPA is divided into 2 parts: performing the procedure; interpretation of results.
- A logbook to track the procedures performed is an optional feature of this EPA.

Assessment Plan:
Direct observation by supervisor
Use Form 1. Form collects information on:
- Setting: inpatient; outpatient; emergency room; simulation
- Procedure: aspiration (dry aspirate acceptable); injection (no ultrasound); both
- Anatomy: shoulder; elbow; wrist; ankle; small joint (MCP, MTP, IP or CMC); other (write in)
- Injection site: none; soft tissue (carpal tunnel, bursae trochanteric, anserine, subacromial); tendons (DeQuervain's, trigger fingers, dactylitis); plantar fasciitis
Collect 4 observations of achievement
- At least 4 of the 5 anatomic sites
- At least 2 aspirations
- At least 1 shoulder
- At least 1 elbow, wrist, or ankle
- At least 1 bursal or soft tissue injection
- At least 1 small joint procedure
- At least 2 assessors

Form

F2: Procedure

Milestones

• ME 3.2. Obtain informed consent for the procedure and therapy

• ME 3.2. Describe the indications and contraindications for the procedure

• ME 3.4. Gather and assess required information prior to the procedure

• ME 3.4. Gather and/or manage the availability of appropriate instruments and materials

• ME 3.4. Prepare and position the patient for the procedure

• ME 3.4. Apply knowledge of anatomy, key landmarks and the procedure

• ME 3.4. Demonstrate aseptic technique: skin preparation, establishing and respecting the sterile field

• ME 3.4. Execute the steps of the procedure in a safe and efficient manner

• ME 2.2. Select appropriate fluid analysis

• ME 3.4. Optimize patient comfort and safety, including the need for analgesia, and modify the procedure as needed

• ME 4.1. Provide discharge instructions and plan for follow-up

• ME 3.4. Prevent and/or manage immediate complications of the procedure

• COM 5.1. Document the encounter to convey the procedure and outcome

Context Variables

• Setting (single-choice)
  • inpatient
  • outpatient
  • emergency room
  • simulation
• Procedure (single-choice)
  • aspiration (dry aspirate acceptable)
  • injection (no ultrasound)
  • both
• Anatomy (single-choice)
  • shoulder
  • elbow
  • wrist
  • ankle
  • small joint (MCP, MTP, IP or CMC)
  • other
• Injection site (single-choice)
  • none
  • soft tissue (carpal tunnel, bursae trochanteric, anserine, subacromial)
  • tendons (DeQuervain's, trigger fingers, dactylitis)
  • plantar fasciitis

Requirements

• Collect 4 observations of achievement (minimum 4)
• At least 4 of the 5 anatomic sites (minimum 4)
• At least 2 aspirations (minimum 2)
  • Only counts when Procedure is aspiration (dry aspirate acceptable)
• At least 1 shoulder (minimum 1)
  • Only counts when Anatomy is shoulder
• At least 1 elbow, wrist, or ankle (minimum 1)
• At least 1 bursal or soft tissue injection (minimum 1)
  • Only counts when Injection site is soft tissue (carpal tunnel, bursae trochanteric, anserine, subacromial)
• At least 1 small joint procedure (minimum 1)
  • Only counts when Anatomy is small joint (MCP, MTP, IP or CMC)
• At least 2 assessors (minimum 2)
  • Counted once per distinct Assessor