bone marrow puncture
1, use
Observe the morphology and classification of cells in bone marrow to help diagnose blood system diseases; Sepsis or some infectious diseases need bone marrow bacterial culture, and some parasitic diseases need smear examination; Malignant tumor suspected of bone marrow metastasis; Used for bone marrow transplantation, etc.
Step 2 instruct
2. 1 Diagnosis of various blood diseases.
2.2 Sepsis, some infectious diseases or parasitic diseases need bone marrow bacterial culture or smear to find plasmodium and Leishmania.
2.3 Diagnosis of reticuloendothelial system diseases.
2.4 Malignant tumor with suspected bone marrow metastasis.
3. Contraindications
Hemophilia, infection and dermatosis at the puncture site are not suitable for puncture.
Use articles
Cleaning plate, bone marrow puncture kit, 2% iodine and 75% alcohol, 5ml and 20ml sterile syringes, sterile gloves, 2% procaine, clean and dry glass slides and push tablets. Bone marrow culture needs 20ml sterile syringe, bacteria culture bottle with culture medium, alcohol lamp and matches.
5. Patient preparation
5. 1 Patients need to take a bath and change their clothes.
5.2 Explain to patients and obtain cooperation.
5.3 Make patients build up confidence and eliminate fear and nervousness.
6. Method
6. 1 Anterior superior iliac spine puncture
6. 1. 1 The patient lies on his back, and a wide margin from 1 to 1.5 cm behind the anterior superior iliac spine is taken as the puncture point. After local routine disinfection, put a hole towel, and local anesthesia should reach the periosteum.
6. 1.2 The thumb and forefinger of the operator's left hand are fixed on the skin inside and outside the anterior superior iliac spine, and the right hand holds the puncture needle to pierce the periosteum vertically, and then enters the bone marrow cavity at 1cm.
6. 1.3 felt frustrated when puncturing the bone marrow cavity, immediately pulled out the needle core, connected to a 20ml sterile dry syringe, and extracted about 0.2ml bone marrow for smear examination; During culture, take 3 ~ 5ml of bone marrow.
6. 1.4 After the operation, insert the needle core back, pull out the needle, apply sterile gauze locally and fix it with adhesive tape.
6.2 Posterior superior spinous puncture
6.2. 1 In the patient's lateral position or prone position, the posterior superior iliac spine generally protrudes above the hip joint and the bones on both sides; Or take the intersection of 6 ~ 8 cm below the upper edge of the bone and 2 ~ 4 cm beside the spine as the puncture point.
6.2.2 The direction of the puncture needle is almost perpendicular to the back and slightly inclined to the outside.
6.3 sternal stalk puncture
6.3. 1 The patient is lying on the treatment table. Shoulder pillow and back pillow make the head lean back as far as possible, and turn left to fully expose the suprasternal notch.
6.3.2 The operator stands on the patient's head. First, he opened his fingers with his left hand, found the notch on the sternum, and pressed the skin against the upper edge of the sternum handle. Insert the needle from the center of the notch along the horizontal direction of the sternum stalk with your right hand, and then slowly rotate and pierce until the median depth of the bone plate on the upper edge of the sternum stalk is about 0.5 ~ 1.0 cm.
6.4 Spinal puncture
6.4. 1 The patient lies on his side or sits back in a chair with his arms on the back of the chair and the headrest arm.
6.4.2 Take the spinous process of the upper lumbar spine as the puncture point, fix the upper and lower skin of the spinous process to be punctured with the thumb and forefinger of the left hand, and puncture vertically from the side or center of the spinous process with the needle in the right hand.
6.5 Tibial puncture (only applicable to children under 2 years old)
6.5. On the1supine table, the lower limbs were fixed by the assistant, and the anteromedial intestinal bone (or the upper-middle L/3 junction of the intestinal bone) about 1cm below the tibial tubercle plane was selected as the puncture point.
6.5.2 Fix the skin with the thumb and forefinger of the left hand, hold the needle in the right hand, and pierce it perpendicular to the middle of the bone surface.
7. Preventive measures
7. 1 The purpose and method of examination should be explained to the patient before operation in order to obtain cooperation.
7.2 Strict aseptic operation to prevent infection.
7.3 The goods are fully prepared.
7.4 After the puncture needle passes through the skin and reaches the periosteum, the needle should be perpendicular to the bone surface, rotate slowly, and hold the needle steadily. Avoid excessive force or needle sliding on the bone surface. If it has penetrated into the marrow cavity, the needle should be fixed at this time.
7.5 When taking bone marrow smear, the negative pressure should be increased slowly, and the suction should be stopped immediately after blood is seen in the syringe to avoid bone marrow dilution. At the same time, if you want to do smear and culture, you should take a little bone marrow smear first, then take bone marrow for culture, and you can't take it out at the same time. After the syringe is taken out, it should be quickly inserted back into the needle core to prevent bone marrow from overflowing.
7.6 When puncturing the sternum handle, the puncture angle must be parallel to the sternum handle, so as to avoid the needle tip slipping or penetrating into the posterior cortex of the sternum handle.
8. Nursing
8. 1 Observe the patient's complexion, pulse and breathing during operation.
8.2 When pulling out the needle, press the puncture point hard until there is no bleeding.
8.3 Observe the puncture site for signs of hematoma, bleeding and infection within 24 hours after operation.
8.4 dressing change at puncture site 1 time/day.
8.5 Tell the patient not to take a bath for three days.