Methods of operation of bone marrow puncture

1. Puncture site selection ① anterior superior iliac spine: the puncture point is usually 1-2 cm above the posterior and upper part of the anterior superior iliac spine, where the bone surface is flat, easy to fix, convenient and safe to operate; ② Posterior superior iliac spine: located on both sides of the sacral vertebra, the bony protrusion above the hip; ③ Manubrium sternum: the bone marrow content is rich here. When puncture failure occurs in the above part, manubrium sternum puncture can be performed. However, the bone is thinner here, and there are atria and large blood vessels behind it, so the risk of penetration is strictly prevented. ④ Lumbar spinous process: located in the source of lumbar spinous process, rarely selected.

2. When puncture the sternum and anterior superior iliac spine, take the supine position. The former should also be padded with pillows behind the back to make the chest slightly protrude. Puncture of the posterior superior iliac spine should be performed in lateral decubitus position. Lumbar spinous process puncture was performed in sitting or lateral decubitus position.

3. Routine disinfection of the skin, wear sterile gloves, spread disinfection cloth, with 2% lidocaine for local infiltration anesthesia until the periosteum.

4. Fix the bone marrow puncture needle fixator at an appropriate length (about 1.5cm for iliac puncture, about 1.0cm for obese people, and about 1.0cm for manubrium puncture), fix the skin at the puncture site with the left thumb and index finger, and vertically Pierce the bone surface with the needle in the right hand (for manubrium puncture, the puncture needle and bone surface should be inserted at an Angle of 30-40 °). When the needle touches the bone, it rotates from side to side and slowly drills the bone marrow. When the resistance disappears and the needle is fixed in the bone, it indicates that the bone marrow cavity has been entered.

5. With a dry 20ml syringe, withdraw the inner plug for 1cm, pull out the needle core, attach the syringe, and slowly aspirate with appropriate strength. A small amount of red bone marrow fluid can be seen to enter the syringe. The amount of bone marrow fluid aspirated is 0.1-0.2 ml. The cells were examined for morphology and cytochemical staining.

6. If bone marrow culture is required, connect the syringe again, aspirate 2 ~ 3ml bone marrow solution and inject it into the culture medium.

7. If you fail to smoke fluid in the bone marrow, could be needle cavity by the skin, subcutaneous tissue or bone stuffing, also may be the needle is too deep or too shallow, tip is not within the pulp cavity, at this time should be to reconnect needle core, rotating or slightly down a little, or quit a few again, pull out the needle core, such as seen with blood on his needle core, suction is expected to obtain bone marrow liquid.

8. After the suction is complete, insert the needle core, rotate slightly and pull out the puncture needle, then cover the needle hole with sterilized gauze, press slightly, and fix it with adhesive tape.

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