What Calls Bone Marrow Needle Channeling Thorn

1. Selection of puncture site

① Anterior superior iliac spine: 1 ~ 2cm above the posterior of the anterior superior iliac spine is often taken as the puncture point, where the bone surface is relatively flat, easy to fix, convenient and safe operation;

② Posterior superior iliac spine: located on both sides of the sacral vertebra, above the hip bone protrusion;

③ Manubrium sternum: The bone marrow content here is rich, when the above part of the puncture failed, can be used for manubrium sternum puncture, but the bone here is thin, there are atrium and large blood vessels behind, to prevent the risk of penetration, less selection;

④ Lumbar spinous process: located in the source of lumbar spinous protrusion, rarely used. 5.2 Anterior and inferior tibial trochanter should be selected for infants under age.

2. Body position

The sternum and anterior superior iliac spine were punctured in supine position. The posterior superior iliac spine should be punctured in the lateral position. The lumbar spinous process puncture was performed in the seated or lateral position.

3. Routine skin disinfection, wear sterile gloves, spread disinfection towel, 2% lidocaine for local infiltration anesthesia to periosteum.

4. Fix the bone marrow puncture needle fixator on an appropriate length (iliac puncture is about 1.5cm, obese patients can be properly lengthed, and manubrium sternum puncture is about 1.0cm), fix the skin of the puncture site with the thumb and indicator finger of the left hand, and Pierce vertically into the bone surface with the needle in the right hand (if manubrium sternum puncture is performed, the needle and the bone surface are pierced at an Angle of 30-40 °). When the needle touches the bone, it rotates around and slowly drills into the bone-piercing substance. When the resistance is felt and the needle has been fixed in the bone, it indicates 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 to the syringe, and slowly aspirate with appropriate force, a small amount of red marrow fluid can be seen into the syringe, the appropriate amount of marrow fluid aspirate should be 0.1-0.2ml, remove the syringe, push the marrow fluid on the slide, the assistant quickly make 5 to 6 smears. The cells were examined by morphology and cytochemical staining.

6. If bone marrow culture is needed, attach a syringe and inject 2 ~ 3ml of bone marrow fluid into the culture medium.

7. If marrow fluid is not extracted, the needle cavity may be filled with skin, subcutaneous tissue or bone pieces, or the needle may be too deep or too shallow, and the needle tip is not in the medullary cavity. At this time, the needle core should be re-inserted, slightly rotated or drilled into or out of a little more, and the needle core should be pulled out.

8. After the suction is complete, insert the needle core and pull out the puncture needle with a slight rotation. Then cover the needle hole with the sterilized gauze, press it slightly, and fix it with tape.