Indicative procedure of bone marrow biopsy (selection point: Superior posterior iliac spine or superior anterior iliac spine)

(1) Correct patient position (related to the selection of puncture site, you can choose a puncture point)

① Puncture point of the posterior superior iliac spine: simulated prone position, on both sides of the sacral vertebra and protruding above the hip

② Puncture point of the anterior superior iliac spine: simulated human supine position, 1-2cm behind the anterior superior iliac spine, and the bone surface was relatively flat

(2) Aseptic operation, disinfection, towel, local anesthesia correct operation routine skin disinfection (diameter about 15cm) The operator wear sterile gloves, towel, 2% lidocaine local anesthesia to periosteum.

Correct operation smooth, basically correct, incorrect, totally wrong

⑶ Puncture operation is correct

① Fix the bone marrow puncture needle fixator on the appropriate length (about 1.5cm for iliac puncture), fix the puncture site with the thumb and indicator finger of the left hand, and Pierce vertically towards the bone surface with the needle in the right hand. When the needle tip touches the bone, rotate the puncture needle around the long axis of the needle body and slowly drill into the bone-piercing substance. When the resistance disappears and the puncture needle is fixed in the bone, It means it has entered the marrow cavity. If the needle is not fixed, drill a little more until it can be fixed

(2) Remove the needle core and prevent it in the sterile dish: connect the dry 10ml or 20ml syringe and suction with appropriate force (if the needle is in the bone marrow cavity, the patient will feel a slight pain during suction), then a small amount of red bone marrow fluid will enter the syringe, and the amount of bone marrow extraction should be 0.1-0.2ml

(3) The bone marrow was dropped on a slide, and a number of smears were quickly prepared for morphological and cytological examination

(4) If the marrow fluid is not extracted, the needle cavity or subcutaneous tissue block may be blocked or dry pumping. At this time, the needle core should be re-inserted, slightly rotated or drilled into or out of a little, and the needle core is pulled out. If the needle core is found with blood, then suction is performed

⑤ After the suction is completed, the needle core is re-inserted and the local skin is disinfected. The sterile gauze is placed at the pinhole with the left hand, and the puncture needle and the needle core are pulled out with the right hand. Then the gauze is covered at the pinhole of the skin and pressed for 1-2 minutes

Analysis:

(1) Correct patient position (related to the selection of puncture site, you can choose a puncture point)

① Puncture point of the posterior superior iliac spine: simulated prone position, on both sides of the sacral vertebra and protruding above the hip

② Puncture point of the anterior superior iliac spine: simulated human supine position, 1-2cm behind the anterior superior iliac spine, and the bone surface was relatively flat

(2) Aseptic operation, disinfection, towel, local anesthesia correct operation routine skin disinfection (diameter about 15cm) The operator wear sterile gloves, towel, 2% lidocaine local anesthesia to periosteum.

Correct operation smooth, basically correct, incorrect, totally wrong

⑶ Puncture operation is correct

① Fix the bone marrow puncture needle fixator on the appropriate length (about 1.5cm for iliac puncture), fix the puncture site with the thumb and indicator finger of the left hand, and Pierce vertically towards the bone surface with the needle in the right hand. When the needle tip touches the bone, rotate the puncture needle around the long axis of the needle body and slowly drill into the bone-piercing substance. When the resistance disappears and the puncture needle is fixed in the bone, It means it has entered the marrow cavity. If the needle is not fixed, drill a little more until it can be fixed

(2) Remove the needle core and prevent it in the sterile dish: connect the dry 10ml or 20ml syringe and suction with appropriate force (if the needle is in the bone marrow cavity, the patient will feel a slight pain during suction), then a small amount of red bone marrow fluid will enter the syringe, and the amount of bone marrow extraction should be 0.1-0.2ml

(3) The bone marrow was dropped on a slide, and a number of smears were quickly prepared for morphological and cytological examination

(4) If the marrow fluid is not extracted, the needle cavity or subcutaneous tissue block may be blocked or dry pumping. At this time, the needle core should be re-inserted, slightly rotated or drilled into or out of a little, and the needle core is pulled out. If the needle core is found with blood, then suction is performed

⑤ After the suction is completed, the needle core is re-inserted and the local skin is disinfected. The sterile gauze is placed at the pinhole with the left hand, and the puncture needle and the needle core are pulled out with the right hand. Then the gauze is covered at the pinhole of the skin and pressed for 1-2 minutes