BONE MARROW BIOPSY AND ASPIRATION – Purpose, Indications, Site and Position of the Patient, General Instructions, Preliminary Assessment, Preparation of the patient and Environment, Equipment, Procedure, Post-procedure care and Complications
Aspiration is defined as sucking a small amount of tissue in to the needle by applying suction with syringe.
Biopsy is defined cutting and removing a small amount of tissue from an area for examination.
Bone marrow aspiration is a diagnostic procedure performed in blood dyscrasias in which a specimen of bone marrow is taken from the sternum, iliac crest posterior superior iliac spine or tibia (children) by means of a hollow thick needle.
PURPOSE
- To diagnose blood dyscrasia, such as aplastic anemia, leukemia, thrombocytopenia, etc
- To diagnose metastatic neoplasm
- To diagnose deficiency states of vit-bitz, folic acid, iron, pyridoxine, etc
- To diagnose toxic states producing bone marrow depression or destruction
- To determine the number, size and shape of red cells, white cells and platelets
- To follow course of disease and patient’s response to treatment
INDICATIONS
Diagnostic: Bone marrow examination is essential for diagnose of a plastic, megaloblastic anemia, multiple myeloma, myelofibrosis, myelosclerosis and aleukemic leukemia.
Bone marrow examination is helpful but not essential for diagnosis of anemia, leukemia, thrombocytopenic purpura, agranulocytoma, tropical diseases; malaria, kala-azar, etc
Prognostic: agranulocytosis, leukemia and anemia
Therapeutic: bone marrow transplant
SITE AND POSITION OF THE PATIENT
Sternal puncture: the usual puncture site is either the manubrium sterni or the upper part of the body of sternum. The patient lies in the dorsal recumbent position (supine) with a pillow under the shoulders to raise the chest.
Iliac puncture: the bone marrow biopsy is taken from the iliac crest 2 cm posterior and 2 cm interior to the anterior superior iliac spine. Alternately, the posterior iliac spine is also used. For iliac puncture, the patient lies either on his side or abdomen.
Spinous process aspiration: in the spinous process of the lumbar vertebrae, usually L3 or L4 is the puncture site. The patient is placed in the lumbar puncture position.
Tibial puncture in children: in children up to the age of two years the proximal end of tibia, just below the tibial condyles and medial to the tibial tuberosity is selected.
GENERAL INSTRUCTIONS
- The procedure should be done under very strict aseptic technique, since the infection can be introduced into the bone cavity through the puncture site
- The penetration of the needle beyond the bone cavity is prevented by a guard attached
PRELIMINARY ASSESSMENT
Check
- The doctors order for any specific instructions
- General condition and diagnosis of the patient
- Self-care ability of the patient
- Mental status to follow instructions
- Availability of articles in the unit
- Location and type of insertion
PREPARATION OF THE PATIENT AND ENVIRONMENT
- Explain the sequence procedure of the patient
- Provide privacy
- A thorough preparation of skin to prevent infection introduced in to the bone cavity
- Place the patient in a correct position according to the site used
- Sedation may be given to the patient
- Arrange the articles at the bedside or in the treatment room
- Check the vital signs of the patient and record it in the nurse’s record sheet
- The nurse should remain with the patient to reassure him and to observe him during the procedure
EQUIPMENT
A sterile tray containing:
- Sponge holding forceps – 1
- Dissecting forceps – 2
- The complications should be watched for injury to associate organs
- The vital signs should be checked throughout the procedure and reassure the patient
- The nurse should remain with the patient throughout the procedure and observe for signs of complications
- Smear is made on 3-4 slides. Specimens are sent to the laboratory without delay
- Marrow puncture needle with obturator – 1
- Aspiration syringe – 1
- Syringe for local anesthesia – 1, needle – 2,
- Small bowls – 2, to take cleaning solutions
- Cotton swabs, gauze pieces, cotton pads, etc. in containers
- Dressing towels or slit to create a sterile field
- BP handle with blade – 1, to make a small incision on the skin
- Slides to make smears
An unsterile tray containing:
- Mackintosh and towel
- Lignocaine 2%
- Adhesive tape and scissors
- Kidney tray and paper bag
- Spirit, iodine, tincture benzoin, etc
PROCEDURE
- Transfer the patient from bed to treatment room
- Position the patient and assess the doctor to locate and mark the site
- Open small dressing pack and slides, syringes, needles and scalpel blade into pack
- Assist the doctor to clean site with antiseptic solution and drape with sterile towels
- A small incision may be made with scalpel blade. Bone marrow needle with stillete is introduced through incision and marrow is aspirated
- Inform patient that a brief episode of sharp pain during aspiration will be experienced
- Syringe with aspirated marrow is handed over to technician and collect into various containers as indicated
- Collect bone marrow tissue in small bottle containing FAA solution
- Apply pressure over punctured site until bleeding ceases
- Assist doctor to seal punctured site with tincture benzoin and apply small from dressing
POST-PROCEDURE CARE
- Keep the patient in supine or lateral position
- Allow the patient to rest for few hours after the procedure
- Check the vital signs and observe for signs and symptoms of complications
- The puncture site should be treated as a surgical wound. The dressing should be done under strict aseptic techniques
- Give mild analgesics if needed
- Label specimen and send to laboratory
- Replace the articles after cleaning
- Wash hands
- Record the procedure in the nurse’s record sheet
COMPLICATIONS
According to the site
- Sterna puncture: injury to the pericardium, myocardium, lungs and to the large blood vessels of the mediastinum
- Iliac site: injury to the sacroiliac ligament, dural sac and cauda equina
- Vertebral site: injury to the dural sac and the spinal cord
- Tibial sac: damage to the tibial collateral ligament of the knee
OTHER COMPLICATIONS
- Bleeding from puncture site. The causes are thrombocytopenia and bleeding diathesis. Bleeding can be prevented by local pressure
- Perforation of aorta, due to penetration of posterior side of sternum if too much force is applied
- Infection (osteomyelitis)
