How to take bone marrow

Bone marrow puncture needle is a commonly used diagnostic technique to take bone marrow fluid, and its examination content includes several aspects such as cytology, protozoa and bacteriology.

A) Indications

1. Diagnosis, differential diagnosis and follow-up treatment of various hematological diseases.

2. Unexplained increase or decrease in the number of red blood cells, white blood cells, platelets and abnormal morphology.

3. Diagnosis and differential diagnosis of fever of unknown origin, can be used for bone marrow culture, bone marrow smear to find parasites, etc.

(2) Operation method

1. Selection of the puncture site ①The anterior superior iliac spine: 1~2cm above the back of the anterior superior iliac spine is often used as the puncture point, where the bone surface is relatively flat, easy to fix, convenient and safe to operate; Bone protruding parts on the side and above the buttocks; ③Sternal stem: This is where the bone marrow content is rich. When the puncture of the above parts fails, the sternal stem can be punctured, but the bone here is thin, and there are atria and large blood vessels afterwards. The risk of translucency is rarely used; ④Lumbar spinous process: located at the protrusion of the lumbar spinous process, rarely used.

2. Position When puncturing the sternum and anterior superior iliac spine, take the supine position. Lateral superior iliac spine puncture should be taken laterally. When puncturing the spinous process of the lumbar spine, take a sitting or lateral position.

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

4. Fix the bone marrow puncture needle holder at an appropriate length (the iliac bone puncture is about 1.5cm, the obese people can lengthen it appropriately, and the sternum stem puncture is about 1.0cm), fix the skin of the puncture site with the thumb and index finger of the left hand, and hold the needle at Pierce the bone surface vertically (if it is a sternal stem puncture, the puncture needle is pierced obliquely at an angle of 30-40° to the bone surface). When the resistance disappears and the puncture needle has been fixed in the bone, it means that it has entered the bone marrow cavity.

5. With a dry 20ml syringe, withdraw the inner plug 1cm, pull out the needle core, connect the syringe, and slowly suck with appropriate strength. It can be seen that a small amount of red bone marrow fluid enters the syringe. The suction volume of bone marrow fluid is 0.1～0.2ml. It is advisable to remove the syringe, push the bone marrow fluid onto the glass slide, and quickly make 5-6 smears by the assistant, and submit them for cell morphology and cytochemical staining.

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