Selection of bone marrow puncture site in children and matters needing attention?

Parts of the

(1) Sternum: the horizontal line between the midline of the sternum body and the first rib. This area is thin and difficult to puncture.

(2) Iliac crest: anterior superior iliac crest or posterior superior iliac crest. The bone marrow cavity here is large, contains a large amount of bone marrow, and there are no important organs nearby. Puncture is safe and widely used in clinic.

(3) Spinous process: Lumbar spine 1-4 spinous process can be selected, generally take the lumbar spine 3-4 spinous process.

Matters needing attention

(1) Patients should wash their hands, wear masks, and dress neatly.

(2) Explain the significance of puncture to the sick child, relieve his concerns, and obtain the cooperation of the sick child.

(3) Take the sick child to the treatment room, such as the operation of the anterior superior iliac crest for bone marrow puncture point, the sick child to supine position. If the surgeon takes the posterior superior iliac crest as the puncture point, the patient takes the kneeling position and exposes the puncture site to the surgeon on the back.

(4) The assistant held the knee joint and waist of the sick child steady.

(5) The skin should be disinfected according to routine procedures, with a diameter of 15-20cm.

(6) The operator wore gloves, covered with hole towel, and made local anesthesia until the periosteum.

(7) the length adjustment device of the bone marrow puncture needle was fixed at 1-1.5cm from the needle tip, and it could be adjusted to 2cm for older children with obesity.

(8) Try to connect the piercing needle and syringe to check whether there is air leakage.

(9) Iliac crest injection method:

① Needle needle method of anterior superior iliac crest, with left middle finger against the anterior superior iliac crest, left index finger, thumb to fix the iliac crest, right hand holding needle 1-2cm behind the anterior superior iliac crest into the vertical with the iliac crest, or 1-2cm behind the anterior superior iliac crest below the horizontal.

② Needle injection into the posterior superior iliac crest, stab the puncture needle vertically at the posterior superior crest on both sides of the sacral vertebra with your hands.

(10) After entering the needle, there is a sense of relaxation. At this time, the hand piercing needle holding the needle released can stably stab on the iliac crest without falling down.

(11) After removing the needle core, quickly press a 30-50ml dry syringe to draw the bone marrow fluid, 0.2-0.3ml for smear and 1-3ml for culture.

(12) Immediately after the completion of the operation, pull out the syringe and needle at the same time for rapid smear, or remove the syringe and hand it to the assistant for smear. Connect the needle core and pull out the needle. The assistant immediately cover the needle hole with sterile gauze, apply light pressure to stop the bleeding, and apply the tape tightly.

(13) Send the sick child back to the ward for rest.

(14) Tidy up the things to be disinfected.

(15) Specimens should be submitted for examination in time.

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