BONE MARROW BIOPSY AND ASPIRATION

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)
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
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

Leave a Comment

Your email address will not be published. Required fields are marked *