What are the dangers of bone marrow acupuncture?

Indications

Bone marrow aspirate is a common diagnostic technique for taking bone marrow fluid, and its examination contents include cytology, protozoa, and bacteriology.

method:

1. Select the puncture site:

1) The puncture point of the anterior superior iliac spine is located 1-2 cm behind the anterior superior iliac spine. The bone surface of this part is relatively flat, which is easy to fix, easy to operate, and has no danger;

2) The puncture point of the posterior superior spine, located on both sides of the sacral vertebra, protruding above the buttocks;

3) The puncture point of the sternum, the manubrium or the body of the sternum is equivalent to the position of the first and second intercostal spaces. The sternum is thin (about 1.0cm), and behind it are the atrium and great blood vessels, to prevent accidents from penetrating the sternum; The fluid content is rich, and when the puncture of other parts fails, sternum puncture is still required; 4) The puncture point of the lumbar spinous process is located at the protrusion of the lumbar spinous process.

2. Position: During puncture of the anterior superior spine of the sternum or iliac spine, the patient is in the supine position. Take the sitting or lateral position during spinous process puncture. The lateral position should be taken during puncture of the posterior superior spine.

3. The local skin is routinely disinfected, and the operator wears sterile gloves. A sterile hole towel was laid, and 2% lidocaine was used for local skin, subcutaneous and periosteal anesthesia.

4. Fix the bone marrow puncture needle fixer at an appropriate length (about 1.0cm for sternum puncture and about 1.5cm for iliac puncture), fix the puncture site with the thumb and index finger of the left hand, and use the right hand to pierce the needle vertically to the bone surface (if For sternum puncture, the needle should be kept at an angle of 30-40 degrees to the bone surface). When the needle tip touches the bone, the needle should be rotated left and right to slowly pierce the bone. When the resistance disappears, and the needle has been fixed in the When it is fleshy, it means that it has entered the bone marrow cavity. If the puncture needle is not fixed, it should be drilled a little more until it can be fixed.

5. Pull out the needle core, connect a dry 10ml or 20ml syringe, and aspirate with appropriate force. If the needle is indeed in the bone marrow cavity, the patient will feel a slight sharp pain during suction, and then a small amount of red bone marrow fluid will enter the syringe. The amount of bone marrow aspirated is preferably 0.1-0.2ml. For bacterial culture in bone marrow fluid, 1-2ml should be extracted after taking bone marrow fluid for counting and smear preparation.

6. The extracted bone marrow was dripped on a glass slide, and nucleated cells were counted and smeared quickly for morphological and cytochemical staining.

7. If the bone marrow fluid cannot be extracted, the needle cavity may be blocked by the skin or subcutaneous tissue or dry pumping. If you see blood on the needle core, you can get bone marrow fluid by aspiration again.

8. After suctioning, take the sterile gauze with the left hand and place it at the pinhole, pull out the puncture needle with the right hand, then cover the gauze on the pinhole, press for 1-2 minutes, and then press and fix the gauze with adhesive tape.

Precautions:

1. The blood coagulation time should be checked before operation, and the patients with bleeding tendency should pay attention to the characteristics of the operation. Bone marrow puncture is prohibited for patients with hemophilia.

2. Syringes and needles must be dry to avoid hemolysis.

3. After the puncture needle enters the bone, avoid swinging too large to avoid breaking; do not use excessive force for sternum puncture to prevent penetrating the medial bone plate.

4. The amount of aspirated fluid should not be too much for cytomorphological examination, as too much will dilute the bone marrow fluid and affect the judgment of nucleated cell proliferation, cell count and classification results.

5. The smear should be smeared immediately after the marrow fluid is removed, otherwise coagulation will occur quickly and the smear will fail

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