An Effective Bedside Lavage Technique for Management of Septic Arthritis of the Ankle

bag.A pressure bag can be inflated around the normal saline bag to increase the rate of fluid flow.Another 18G needle is placed in the anteromedial portal, and egress of the normal saline confirms accurate positioning (Fig. 2).The needle in the anteromedial portal is connected to wall suction to permit continuous irrigation of the ankle.The portals can be "switched" (ingress through anteromedial and egress through anterolateral portals) if needed.If synovium restricts inflow or outflow, an additional "posterolateral portal" can be used to allow permit gravity-aided egress of the lavage fluid.This is made approximately an inch above the tip of the lateral malleolus, between the Achilles tendon medially, and the peroneal tendons laterally.Lavage is continued with 8-10 liters of saline or until fluid is clear; broad-spectrum antibiotics can be added.At the end of the procedure, the effluent should be clear.If postprocedural collection is anticipated, a suction drain can be inserted via a stab incision through one of the portals.