Bone needle operation method

1. Selection of puncture site: Anterior superior iliac spine: usually 1 to 2 cm behind and above the anterior superior iliac spine as the puncture point, where the bone surface is flat, easy to fix, convenient and safe to operate; Posterior superior iliac spine: located at the two sacral vertebrae. The bony prominence of the side and the upper part of the buttocks; the manubrium: the bone marrow is rich here. When the puncture of the above parts fails, the manubrium can be punctured. Dangerous, less used; lumbar spinous process: located at the protrusion of the lumbar spinous process, rarely used.

2. Posture: The supine position is taken when the sternum and the anterior superior iliac spine are punctured. The lateral decubitus position should be taken during puncture of the posterior superior iliac spine. The lumbar spinous process was punctured in a sitting or lateral position.

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

4. Fix the needle holder for bone marrow puncture at an appropriate length (about 1.5cm for iliac puncture, lengthen for obese patients, and about 1.0cm for sternum puncture), fix the skin at the puncture site with the thumb and index finger of the left hand, and hold the needle in the right hand. Perpendicularly penetrate the bone surface (in the case of manubrium puncture, the puncture needle and the bone surface should be punctured at an angle of 30 to 40 degree ), when the puncture needle touches the bone, rotate it left and right, and slowly pierce the bone. When the resistance disappears and the puncture needle is fixed in the bone, it indicates that it has entered the bone marrow cavity

5. With a dry 20ml syringe, withdraw the inner plug by 1cm, pull out the needle core, connect the syringe, and slowly aspirate with appropriate force, a small amount of red marrow fluid can be seen entering the syringe, and the amount of marrow fluid aspirated is 0.1-0.2ml. If appropriate, remove the syringe, push the bone marrow fluid on the glass slide, and quickly make 5 to 6 smears by the assistant, and send them for examination of cell morphology and cytochemical staining.

6. For bone marrow culture, connect the syringe and aspirate 2-3ml of bone marrow fluid into the culture medium.

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

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

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