May I ask the selection and precautions of the bone marrow puncture site in children?

Site (1) Sternum: The intersection of the midline of the sternum and the horizontal line between the first rib. It is thinner here, and the puncture is difficult. (2) Ilium: Anterior superior iliac crest or posterior superior iliac crest. The bone marrow cavity here is large and contains a large amount of bone marrow, and there are no important organs nearby. The puncture is safe and widely used in clinical practice. (3) Spinous process: Spinous processes of 1-4 lumbar vertebrae can be selected, generally 3-4 lumbar vertebrae spinous processes are selected. Matters needing attention (1) The operator washes hands, wears a mask, and has neat clothes and hats. (2) Explain the meaning of puncture to the sick child, relieve their concerns, and obtain the cooperation of the sick child. (3) Bring the sick child to the treatment room. For example, the operator takes the anterior superior iliac crest as the bone marrow puncture point, and the sick child takes the supine position. For example, the operator takes the posterior superior iliac crest as the puncture point, and the patient is placed in the lateral position with the knee flexed, with the back to the operator to expose the puncture site. (4) The assistant stabilizes the knee joints and waist of the sick child. (5) Disinfect the skin as usual, and the disinfection range is 15-20cm in diameter. (6) The operator wears gloves, a perforated towel, and performs local anesthesia until the periosteum. (7) Fix the length adjustment device of the bone marrow puncture needle at 1-1.5cm away from the needle tip, and adjust it to 2cm for obese and elderly children. (8) Try connecting the puncture needle and the syringe to check for air leakage. (9) Acupuncture method of iliac bone: ① Acupuncture method of anterior superior iliac crest, press the left middle finger against the anterior superior iliac crest, fix the iliac bone with the index finger and thumb of the left hand, and hold the needle in the right hand at 1-2 cm behind the anterior superior iliac crest and the iliac crest. The iliac crest is inserted vertically, or horizontally below 1-2cm behind the anterior superior iliac crest. ②In the method of needle insertion in the posterior superior iliac crest, the puncture needle is inserted vertically at the posterior superior crest on both sides of the sacral vertebra by hand. (10) There is a feeling of emptiness after the needle is inserted. At this time, the hand puncture needle holding the needle can be stably pierced on the iliac bone without falling down. (11) After taking out the needle core, quickly press the 30-50ml dry syringe to suck the bone marrow fluid, 0.2-0.3ml for smear and 1-3ml for culture. (12) Immediately after the operation is completed, the syringe and the needle are pulled out at the same time to quickly smear, or the syringe is removed and handed to the assistant for smearing. Connect the needle core and pull out the needle, the assistant immediately covers the needle hole with sterile gauze, gently presses to stop the bleeding, and sticks to the tape. (13) Send the sick child back to the ward to rest. (14) Arrange the items and wait for disinfection. (15) Specimens should be sent for inspection in time.

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