How to extract the bone marrow by needle aspiration

1. Selection of puncture site ① Anterior superior iliac spine: The puncture point is usually 1 to 2 cm behind and above the anterior superior iliac spine, where the bone surface is relatively flat, easy to fix, and the operation is convenient and safe; ② Anterior and posterior superior spine: It is located on the two sides of the sacral vertebra. The bony protruding part on the side and above the buttocks; 3. Manubrium: the bone marrow is rich here. When the puncture of the above-mentioned parts fails, the manubrium can be punctured. Because of the danger of penetration, it is less used; ④ Spinous process of lumbar spine: it is located at the protrusion of the spinous process of lumbar spine, and it is rarely used.

2. Posture The supine position was taken when the sternum and the anterior superior iliac spine were punctured. The lateral decubitus position should be taken during puncture of the posterior superior iliac spine. The lumbar spinous process was punctured in a sitting or lateral position.

3. Routinely disinfect the skin, wear sterile gloves, lay a sterile towel, and use 2% lidocaine for local infiltration anesthesia until the periosteum.

4. Fix the bone marrow puncture needle fixer at an appropriate length (about 1.5cm for iliac puncture, the length can be appropriately lengthened for obese patients, and about 1.0cm for sternum puncture), fix the skin at the puncture site with the thumb and index finger of the left hand, and hold the needle in the right hand. Perpendicularly penetrate the bone surface (in the case of manubrium puncture, the puncture needle and the bone surface should be punctured at an angle of 30 to 40°), when the puncture needle touches the bone, rotate it left and right, and slowly pierce the bone. When the resistance disappears and the puncture needle is fixed in the bone, it indicates that it has entered the marrow cavity.

5. With a dry 20ml syringe, withdraw the inner plug by 1cm, pull out the needle core, connect the syringe, and slowly aspirate with appropriate force, a small amount of red marrow fluid can be seen entering the syringe, and the amount of marrow fluid aspirated is 0.1-0.2ml. If appropriate, remove the syringe, push the bone marrow fluid on the glass slide, and quickly make 5 to 6 smears by the assistant, and send them for examination of cell morphology and cytochemical staining.

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