What matters need to notice before doing bone marrow puncture needle?

Currently, iliac crest (anterior superior iliac spine, posterior superior iliac spine), spinal process, sternum, and tibia are commonly used for bone marrow puncture (only for children under 2 years old).

Anterior superior iliac spine puncture: The patient was in the supine position, and the puncture point was about 1~2cm behind the tip of the anterior superior iliac spine.

Posterior superior iliac spine puncture: The patient lies on the side (children lie prone), and the posterior superior iliac spine is generally obviously protruding from the buttocks, or it can be punctured at the level of the fifth lumbar spine and about 3cm by hand. It is a blunt circular protrusion.

Sternal puncture: The patient was supine (occipitocervated), the midline of the sternum was taken, and the upper end of the sternal body equivalent to the level of the second intercostal was the puncture point.

Spinal puncture: the patient lies on the side with the arms clasping the knees; Or sit backwards in a chair with your arms on the back of the chair and your head resting on your arms. The 3rd and 4th lumbar vertebrae were selected as puncture points, and were punctured vertically from the lateral or central spinous process.

Tibial puncture: The puncture point was the medial tibia 1cm below the plane of the tibial tubercle (or the junction of the upper middle third of the tibia) before the tibial tubercle.

Points to note:

① Explain the necessity and safety of puncture examination to the patient before surgery, and explain the examination methods, so as to obtain cooperation.

② Pay attention to aseptic operation and check whether the instruments used are compatible.

(3) Select the correct site, the operation is gentle, the whole process of puncture should quickly puncture the needle through the skin to reach the periosteum, the needle should be perpendicular to the bone surface, slowly rotate into the needle. Do not exert too much force or slide the tip on the bone surface.

(4) The negative pressure should be increased slowly when the bone marrow smear is extracted. When blood is found in the syringe, the suction should be stopped immediately to avoid bone marrow dilution. At the same time to do other tests, should first extract a small amount of bone marrow smear, then extract bone marrow to send other tests (not and do 1). When removing the syringe, the needle core should be inserted quickly to prevent bone marrow fluid spill.

⑤ During sternal puncture, the puncture Angle must be parallel to the manubrium sternum (or the needle manubrium should be tilted at an Angle of 75° to the abdomen) to prevent the needle tip from slipping off or penetrating the posterior cortex of the manubrium sternum.

⑥ If the puncture fails once and needs to be re-pierced, if the puncture needle has been stained with blood, the puncture needle should be replaced. Do not rub the needle core on gauze or cotton ball and insert the needle core back and forth. Suggest to go to the hospital to find a relevant, professional doctor to do a detailed examination or consultation! To prove the drug ah!!