Operation Method Of Bone Marrow Puncture Needle Puncture

1. Selection of the puncture site ①The anterior superior iliac spine: 1~2cm above the back of the anterior superior iliac spine is often used as the puncture point, where the bone surface is relatively flat, easy to fix, convenient and safe to operate; ②posterior superior iliac spine: located in the sacral spine Bone protruding parts on both sides and above the buttocks; ③Sternal stem: This is where the bone marrow content is rich. When the puncture fails at the above parts, the sternal stem can be punctured, but the bone here is thin, and there are atria and large blood vessels behind. Penetration is dangerous and is rarely used; ④Lumbar spinous process: Located at the protrusion of the lumbar spinous process, it is rarely used.

2. Position When puncturing the sternum and anterior superior iliac spine, take the supine position. The former needs to be cushioned on the back to make the chest slightly protrude. Lateral superior iliac spine puncture should be taken laterally. When puncturing the spinous process of the lumbar spine, take a sitting or lateral position.

3. Routinely disinfect the skin, wear sterile gloves, spread a sterile hole towel, and use 2% lidocaine for local infiltration anesthesia until the periosteum.

4. Fix the bone marrow puncture needle holder at an appropriate length (the iliac bone puncture is about 1.5cm, the obese people can lengthen it appropriately, and the sternal stem puncture is about 1.0cm), fix the skin of the puncture site with the thumb and index finger of the left hand, and hold the needle at Pierce the bone surface vertically (if it is a sternal stem puncture, the puncture needle is pierced obliquely at an angle of 30-40° to the bone surface). When the resistance disappears and the puncture needle has been fixed in the bone, it means that it has entered the bone marrow cavity.

5. With a dry 20ml syringe, withdraw the inner plug 1cm, pull out the needle core, connect the syringe, and slowly suck with appropriate strength. It can be seen that a small amount of red bone marrow fluid enters the syringe. The suction volume of bone marrow fluid is 0.1～0.2ml. It is advisable to remove the syringe, push the bone marrow fluid onto the glass slide, and the assistant will quickly make 5 to 6 smears, and submit them for cell morphology and cytochemical staining.

6. If bone marrow culture is needed, connect the syringe again, and suck 2~3ml of bone marrow fluid into the culture medium.

7. If the bone marrow fluid cannot be drawn, the needle cavity may be filled with skin, subcutaneous tissue or bone fragments, or the needle may be inserted too deep or too shallow, and the needle tip is not in the medullary cavity. At this time, the needle core should be reinserted. , Rotate it a little bit or drill in a little more or withdraw a little more, pull out the needle core, if you see blood stains on the needle core, you can expect to get bone marrow fluid by aspirating again.

8. After the suction is completed, insert the needle core, turn slightly to pull out the puncture needle, then cover the needle hole with sterile gauze, press it slightly, and fix it with tape.

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