Bone marrow puncture needle operation

1. Selection of puncture site:

① Anterior superior iliac spine: 1 ~ 2cm above the posterior anterior superior iliac spine is often taken as the puncture point, where the bone surface is relatively flat, easy to fix, convenient and safe operation; (2) Posterior superior iliac spine: located on both sides of the sacral vertebra and the bony protrusion above the buttocks; (3) Manubrium sternum: there is abundant bone marrow here. When the above part of the puncture fails, manubrium sternum puncture can be used, but the bone here is thin, followed by atrium and great vessels, so it is seldom used to prevent the risk of penetration; ④ Lumbar spinous process: located in the source of lumbar spinous process, rarely selected.

2. Position:

The sternum and anterior superior iliac spine should be punctured in supine position. The former should also be placed behind with a pillow to make the chest protrude slightly. The posterior superior iliac spine should be punctured in lateral decubitus position. Lumbar spinous process puncture was performed in sitting or lateral decubitus position.

3. Routine disinfection:

The skin was covered with sterile gloves and sterilized towel. Local anesthesia was performed with 2% lidocaine until the periosteum.

4. Puncture:

Fix the fixator of the bone marrow puncture needle on the appropriate length (iliac bone puncture is about 1.5cm, fat people can be appropriately extended, and manubrium sternum puncture is about 1.0cm), fix the skin at the puncture site with the left thumb and index finger, and insert the needle vertically on the bone surface with the right hand (for manubrium sternum puncture, the puncture needle and the bone surface are inserted at an Angle of 30-40 ° at an oblique Angle). When the puncture needle touches the bone, it rotates left and right and slowly drills the bone marrow. When the resistance disappears and the puncture needle is fixed in the bone, it indicates that the bone marrow cavity has entered.

5. Inspection:

With a dry 20ml syringe, withdraw the inner plug 1cm, pull out the needle core, connect the syringe, and suction slowly with appropriate strength, a small amount of red marrow fluid can be seen into the syringe, the marrow fluid suction amount is appropriate for 0.1-0.2ml, remove the syringe, push the marrow fluid on the slide, and the assistant makes 5 ~ 6 smears quickly. Cell morphology and cytochemical staining were examined.

If bone marrow culture is required, then attach the syringe and inject 2 ~ 3ml of bone marrow solution into the culture medium.

6. Operation completed:

After suction, insert the needle core, gently rotate and pull out the needle, then cover the needle hole with sterilized gauze, press slightly, and fix it with adhesive tape. And explain matters needing attention.

7. Special circumstances:

Such as failure to smoke fluid in the bone marrow, could be needle cavity by the skin, subcutaneous tissue or bone stuffing, also may be the needle is too deep or too shallow, tip is not within the pulp cavity, at this time should be to reconnect needle core, rotating or slightly down a little, or quit a few again, pull out the needle core, such as seen with blood on his needle core, suction is expected to obtain bone marrow liquid.

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