L'asepsie en échographie interventionnelle

Osteoarticular interventional injections guided with ultrasound are playing an increasingly role in Rheumatology. The simultaneous handling of the probe and the needle might suggest the need to take greater aseptic precautions with respect to actions usually performed in anatomical injections. Are they justified? We have no data going in this direction, and a randomized study is impossible because of the rarity of events. We review the different parameters of the aseptic procedure, about the patient (primarily skin disinfection), about the practitioner (mainly wearing sterile gloves or not) and material (protection of ultrasound probe and distance to the needle). The procedure is probably at least as important as the material. Attention needs to be focused on the integrity of the asepsis of the needle. We may not prick into the gel because we can bring non-biodegradable polyacrylate or propylene glycol in tissues. We cannot conclude that the inflation of aseptic measures implemented during a musculoskeletal ultrasound guided gesture is justified. Nevertheless, for some more complex and aggressive gestures, for some fragile patients, and according to the place of practice, we can consider more important infection control procedures, but in the same way as a usual gestures. Only practices observatory, not only by the number of repair procedures administered by the physical damage insurance, but prospectively and on a very large scale at a national level to bring us more precise answers.