Injection Technique

Clean

After marking the location for the injection, apply alcohol, and
swab injection site with hyphenate povidone-iodine preparation (e.g.
betadine ^®).

* Do not concomitantly use disinfectants containing quaternary
ammonium salts for skin preparation because
hyaluronan can precipitate in their presence.

Local anesthesia

Numbing the skin with an ethyl chloride spray or lidocaine injection prior to intra-articular injection may help patients feel more comfortable. If ethyl chloride spray is used, the injection site will need to be cleaned again as per instructions above.

Aspirate

Insert the appropriate gauge needle (18- to 20-gauge for Synvisc-One; 18- to 22-gauge for SYNVISC); this needle size optimizes fluid dynamics and may help make aspiration and the injection easier. Aspiration confirms accurate needle placement inside the joint space and allows removal of synovial fluid and effusion.

Remove any synovial fluid or effusion before injecting SYNVISC/Synvisc-One. Strict adherence to aseptic technique must be followed.

SYNVISC/Synvisc-One injection

Inject SYNVISC/Synvisc-One using standard techniques; patients should flex and bend the knee 3 to 4 times following injection.

Do not inject SYNVISC/Synvisc-One extra-articularly, into the synovial tissues, into the fat pad or joint capsule, or intravascularly.

Set patient expectations and post-procedure education

Tell your patients to:

• Avoid putting a lot of strain — such as jogging, lifting or prolonged standing — on the knee for 48 hours after the injection treatment or as recommended
• Care for mild pain or swelling at the injection site by keeping an ice pack on the knee for 10 minutes or as recommended
• Report any side effects to you or their healthcare team

Make sure to remind them that most patients reported pain relief starting at four weeks after treatment for knee osteoarthritis with Synvisc-One or even as early as 1 week with SYNVISC.