Does bone marrow puncture needle have why harm?

indications

Bone marrow puncture is a common diagnostic technique using bone marrow fluid. The examination contents include cytology, protozoa and bacteriology.

Methods:

1. Select puncture site:

1) The puncture point of anterior superior iliac spine was located 1-2cm behind the anterior superior iliac spine. The bone surface was relatively flat, easy to fix, easy to operate and no risk;

2) The puncture point of the posterior superior iliac spine was located on both sides of the sacral vertebra and the prominent part above the buttocks;

3) Sternal puncture point: the sternal manubrium or sternal body is equivalent to the first and second intercostal space. The sternal bone is thin (about 1.0cm), and the atrium and large blood vessels are behind it to prevent accidents from penetrating the sternal bone; However, due to the rich content of bone marrow fluid in the sternum, sternal puncture is still necessary when puncture in other parts fails. 4) Puncture point of lumbar spine process, located at the source of lumbar spine process.

2. Position: The patient is supine for puncture of the sternum or anterior superior iliac spine. The spinous process puncture was performed in sitting or lateral decubitus position. The posterior superior iliac spine should be punctured in lateral decubitus position.

3. Routine disinfection of local skin, operator with sterile gloves. Sterile cloth was spread, and local skin, subcutaneous and periosteal anesthesia was performed with 2% lidocaine.

4. To fix bone marrow puncture needle holder on the appropriate length (sternum puncture is about 1.0 cm, skeletons of bone biopsy is about 1.5 cm), with left thumb and index finger puncture, pierced with the right hand holding needle to the bone surface vertical (for sternal puncture, should maintain the surface of the needle body and bone into 30-40 degree Angle), when after bone will rotate around puncture needle, needle point contact Slowly drill the bone marrow, when the resistance disappears, and the needle has been fixed in the bone, that has entered the bone marrow cavity. If the needle is not fixed, drill a little more until it can be fixed.

5. Pull out the needle core, connect a dry 10ml or 20ml syringe, and aspirate with appropriate force. If the needle is in the bone marrow cavity, the patient will feel a slight sharp pain during aspiration, and then a small amount of red bone marrow fluid will enter the syringe. The appropriate amount of bone marrow absorption is 0.1-0.2ml. For bacterial culture of bone marrow fluid, 1-2ml should be drawn after the bone marrow fluid is kept for counting and smear specimen preparation.

6. The bone marrow droplets were placed on a slide, and the nucleated cells were counted and the number of smears were prepared for morphological and cytochemical staining.

7. If the bone marrow fluid fails to be extracted, the needle cavity may be blocked or dried by skin or subcutaneous tissue. At this time, the needle core should be inserted again, slightly rotated or drilled in or withdrawn, and the needle core should be pulled out. If blood is found in the needle core, aspirate again to obtain the bone marrow fluid.

8. After the suction, take sterile gauze and place it at the pinhole with the left hand, pull out the puncture needle with the right hand, then cover the gauze over the pinhole and press it for 1-2 minutes, then fix the gauze with adhesive tape.

Points for attention:

1. Preoperative examination of blood clotting time should be performed, and special attention should be paid to patients with bleeding tendency during operation. Bone marrow puncture is forbidden for patients with hemophilia.

2. Syringes and puncture needles must be dried to avoid hemolysis.

3. The needle head into the bone to avoid swinging too large, so as not to break; Sternal puncture should not be too hard to prevent penetration of the medial plate.

4. The amount of aspirated fluid should not be too much for the examination of cell morphology. Too much fluid will dilute the bone marrow fluid and affect the judgment of proliferation degree, cell count and classification of nucleated cells.

5. Bone marrow fluid should be taken out immediately after smear, otherwise coagulation will occur very quickly, so that smear failure

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