Does a bone marrow test hurt?

Painful; Tolerable; Pain relief with local anesthesia; Bone marrow aspiration

1. Purpose 

Observe the morphology and classification of cells in the bone marrow to assist in the diagnosis of hematological diseases; septicemia or certain infectious diseases require bone marrow bacterial culture and smears to check certain parasitic diseases; malignant tumors are suspected of bone marrow metastasis; used for bone marrow transplantation, etc.

2. Indications

2.1 Diagnosis of various blood diseases.

2.2 For septicemia, certain infectious or parasitic diseases, bacterial culture or smear of bone marrow should be used to look for Plasmodium and kala-azar.

2.3 Diagnosis of reticuloendothelial system diseases.

2.4 Malignant tumors suspected of bone marrow metastasis.

3. Contraindications

Hemophilia and puncture site infection and skin disease should not be performed puncture.

4. use

Clean plate, bone marrow puncture bag, 2% iodine and 75% alcohol, 5ml and 20ml sterile syringes, sterile gloves, 2% procaine, clean and dry slides, push slides, for bone marrow culture, another 20ml is required Sterilized syringe, bacterial culture bottle with culture medium, alcohol lamp, matches.

5. Patient Preparation

5.1 The patient needs to take a bath and change to clean clothes.

5.2 Explain the work to the patient to obtain cooperation.

5.3 To build up confidence in patients and eliminate their fear and nervousness.

6. method 

6.1 Anterior superior iliac spine puncture

6.1.1 The patient is supine, and a relatively wide segment of the anterior superior iliac spine 1-1.5 cm back is taken as the puncture point. After routine local disinfection, a hole towel is laid, and the local anesthesia should reach the periosteum.

6.1.2 The operator's left thumb and forefinger pinpoint the skin on the inside and outside of the anterior superior iliac spine, respectively, and the right hand holds the puncture needle vertically to penetrate the periosteum and then advance 1cm to reach the bone marrow cavity.

6.1.3 When piercing the bone marrow cavity, there is a sense of loss, immediately pull out the needle core, connect a 20ml sterile dry syringe, and extract about 0.2ml of bone marrow for smear examination; for culture, take 3 to 5ml of bone marrow.

6.1.4 Insert the needle core back after the operation, pull out the needle, apply sterile gauze locally, and fix it with adhesive tape.

6.2 Posterior superior spine puncture

6.2.1 When the patient is lying on the side or prone, the posterior superior iliac spine generally protrudes above the buttocks, on both sides of the able bone; or the intersection of 6-8 cm below the upper edge of the skeleton and 2-4 cm lateral to the spine is taken as the puncture point .

6.2.2 The direction of the puncture needle is almost perpendicular to the back and slightly inclined to the outside.

6.3 Manubular puncture

6.3.1 The patient is placed supine on the treatment table, with a pillow on the shoulder and back to make the head tilt back as much as possible, and turn to the left to fully expose the suprasternal notch.

6.3.2 The operator stands on the patient’s head, first uncovers the suprasternal notch with the left hand, and presses the skin down against the upper edge of the manubrium, holding the needle with the right hand from the center of the notch along the level of the manubrium. Insert the needle in the same direction, slowly rotate and pierce, and reach the midline depth of about 0.5-1.0 cm of the bone plate on the upper edge of the manubrium.

6.4 Spinous process puncture

6.4.1 The patient should lie on the side or sit on the chair in reverse, with both arms on the back of the chair, and the head rests on the arms.

6.4.2 The spinous process of the upper lumbar vertebra is used as the puncture point. The left thumb and index finger are used to fix the skin above and below the spinous process to be punctured, and the needle is held in the right to pierce vertically from the side or center of the spinous process.

6.5 Tibial puncture (only for children under 2 years old)

6.5.1 The child lies supine on the treatment table, the lower limb is fixed by the assistant, and the medial iliac bone is selected as the puncture point about 1cm below the plane of the tibial tubercle (or the junction of the upper and middle 1/3 of the iliac bone).

6.5.2 Fix the skin with the thumb and forefinger of the left hand, hold the needle in the right hand, and pierce it in a vertical direction in the middle of the bone surface.

7. Precautions 

7.1 Before the operation, the purpose and method of the examination should be explained to the patient in order to obtain cooperation.

7.2 Strict aseptic operation to prevent infection.

7.3 Items are ready.

7.4 After the puncture needle reaches the periosteum through the skin, the needle should be perpendicular to the bone surface, and the needle should be rotated slowly to enter the needle. If the bone marrow cavity has been pierced, the needle should be fixed at this time.

7.5 When taking a bone marrow smear for examination, the negative pressure should be slowly increased. When blood is seen in the syringe, the suction should be stopped immediately to avoid bone marrow dilution. For those who want to do smear and culture at the same time, a few smears of bone marrow should be taken first, and then the bone marrow should be taken for culture. When removing the syringe, insert the needle back quickly to prevent marrow spillage.

7.6 When puncturing the manubrium, the puncture angle must be parallel to the manubrium to prevent the needle tip from slipping off or piercing the posterior cortex of the manubrium.

8. care

8.1 Pay attention to the patient's complexion, pulse, and respiration during the operation.

8.2 When pulling out the needle, press the puncture point hard until no bleeding occurs.

8.3 The puncture site was observed for signs of hematoma, bleeding and infection within 24 hours after operation.

8.4 Change the dressing at the puncture site once a day.

8.5 Instruct the patient not to take a bath within three days.

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