What precautions should be taken before a bone marrow aspiration?

At present, the commonly used bone marrow puncture sites are the ilium (anterior superior iliac spine, posterior superior iliac spine), spinal process, sternum, and tibia (only for children under 2 years old).

Anterior superior iliac spine puncture: the patient is placed in the supine position, and the puncture point is about 1-2 cm behind the top of the anterior superior iliac spine.

Posterior superior iliac spine puncture: the patient is lying on the side (the child is prone), the posterior superior iliac spine is generally prominently protruding from the buttocks, or it can be pressed by hand at the level of the fifth lumbar vertebra, about 3cm away from the side, and it is a blunt circle Puncture at the protrusion.

Sternocentesis: The patient is supine (with the pillow removed), and the midline of the sternum is taken, and the upper end of the sternum at the level of the second intercostal space is the puncture point.

Spinacentesis: The patient lies on his side with his arms tucked over his knees; or sits upside down on a chair with both arms on the back of the chair and the head rests on the arms. Take the 3rd and 4th lumbar vertebrae as the puncture point, and puncture vertically from the side or center of the spinous process.

Tibial puncture: Select the anterior medial tibia 1cm below the tibial tubercle plane (or the junction of the upper and middle 1/3 of the tibia) as the puncture point.

Precautions:

① Explain the necessity and safety of the puncture examination to the patient before the operation, and explain the examination method to obtain cooperation.

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

③Choose the right part and operate gently. The whole puncture process should be done quickly. After the needle reaches the periosteum through the skin, the needle should be perpendicular to the bone surface, and the needle should be rotated slowly. Do not use excessive force or the tip of the needle slips on the bone surface.

④ The negative pressure should be slowly increased when taking the bone marrow smear. When blood is seen in the syringe, the suction should be stopped immediately to avoid bone marrow dilution. At the same time, those who do other inspections should first take a small amount of bone marrow smear, and then take the bone marrow to send for other inspections (not to be done at the same time). When removing the syringe, insert the needle back quickly to prevent the marrow fluid from spilling out.

⑤ When puncturing the sternum, the puncture angle must be parallel to the manubrium (or the needle handle is inclined at a 75° angle to the upper abdomen) to prevent the needle tip from slipping or piercing the posterior cortex of the manubrium.

⑥ When the puncture fails once and needs to be re-punctured, if the puncture needle is stained with blood, the puncture needle should be replaced. Do not rub the needle core on gauze or cotton balls or insert the needle core back and forth into the puncture needle. It is recommended to go to the hospital to find a related, professional doctor for a detailed examination or consultation! To prove the drug ah! !

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