Bone marrow specimen collection how puncture?

Bone puncture is one of the basic operation skills that professional physicians must master

1. Selection of puncture site ① Anterior superior iliac spine: 1 ~ 2cm above the posterior anterior superior iliac spine is usually 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; This is where bone marrow biopsies are often taken. (3) Manubrium sternum: it is often used in children, where the bone marrow is rich. When the puncture fails in the above part, the bone here is thin, followed by atrium and great vessels, so as to prevent the risk of penetration, it is seldom used;

2. Position When the sternum and the anterior superior iliac spine are punctured, supine position is taken. The former also needs to be placed behind with a pillow to make the chest slightly prominent. 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. The skin was routinely disinfected, sterile gloves were worn, disinfection towel was laid, and 2% lidocaine was used for local infiltration and anesthesia up to the periosteum.

4. Fix the fixator of bone marrow puncture needle on an appropriate length (iliac bone puncture is about 1.5cm, and for fat patients, it 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 will be inserted at an Angle of 30-40 ° at an oblique Angle with the bone surface). 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. Withdraw the inner plug 1cm with a dry 20ml syringe, pull out the needle core, attach 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 volume is 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.

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

7. If you fail 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.

8. After suction, insert the needle core, gently rotate and pull out the needle, then cover the needle hole with sterilized gauze, press it slightly, and fix it with adhesive tape. Instruct the patient to keep the area clean and dry.

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