Arthrocentesis is contraindicated if infection of any kind covers the joint-one of the emergency indications for arthrocentesis is obtaining joint fluid for analysis. arthrocentesis is contraindicated if infection of any kind covers the area to be punctured. the synovial fluid should be sent for cell count, differential, grams stain, crystal analysis, and culture. a positive grams stain is diagnostic, but a negative result does not rule out septic arthritis, therefore cultures should always be obtained. the likelihood ratio for septic arthritis increases as the joint wbc rises, however low wbc counts do occur early in infectious arthritis and partially treated arthritis. most of the cells in both septic and severe inflammatory arthritis are pmns. cell counts should not be used to absolutely rule out a septic etiology; bacterial cultures should be obtained. the most serious complication of arthrocentesis is introducing infection into the joint space. other complications include bleeding, allergic reaction to anesthetic agents, dry taps. (chapter 114)
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