UNIT : 5PAEDIATRIC PROCEDURES:

BONE MARROW ASPIRATION

Deepa shresthaB.Sc. Nursing 2nd year

DEFINITION

Removal of small amount of bone marrow fluid through a needle put into bone.

INDICATIONS

• Investigation of unexplained anemia , abnormal red cell indices, cytopenias or cytoses,

• Investigation of abnormal peripheral blood smear suggestive of bone marrow pathology,

• Diagnosis , staging and follow up of maligant haematological disorders ,

CONTD…

• Investigation of suspected bone marrow metastases,

• Unexplained focal bony lesions on radiological imaging,

• Unexplained organomegaly or presence of mass lesions unavailable for biopsy,

CONTD….

• Microbiological culture for pyrexia of unknown origin or specific infections , eg. Miliary tuberculosis , leishmaniasis , malaria,

• Evaluation of iron stores,

• Investigation of lipid/glycogen storage disorders,,

CONTD…

• Exclusion of hematological disease in potential allogenic stem cell transplant donors,

COMMON SITES

Iliac Crest ( posterial and superior part, client lie on lateral or prone position)

Sternum (2nd space of sternum)

Tibia Crest ( babies below 1 year)

ILIAC CREST STERNUM

EQUIPMENTS

1. Sterile gloves

2. Sterile drape

3. Povidone iodine

4. Bone marrow aspiration needle or 11 or 13 gauze Jamshidi needle

5. 22 and 25 gauge needles

TYPES OF NEEDLES

KLIMA NEEDLE JAMSHIDI NEEDLE

CONTD….

• No. 11 scalpel blade

• Heparinized 10 cc syringe

• 1 % lignocaine

• Glasss slides (10)

• Specimen bottle with formalin

EQUIPMENTS

CONTD…..

• 4” 4” Gauze

• Pressure dressing and tape

SITE AND POSITION

PROCEDURE

Physical preparation• Make sure the doctor have obtain consent

from client• Provide clear explanation• Make sure the puncture site has been

cleaned• check vital sign.

BEFORE

Prepare equipments

• Prepare trolley aseptically

• Make sure equipments are complete

During procedure

Help client to remain in the right position Assist the doctor in the procedure.

( Prepare the equipments and hold the client)

Monitor vital signs during procedure to dectect complication.

AFTER PROCEDURE

Place the client in supine position and apply sandbag at the puncture site at least for 6 hours to prevent bleeding complication.

Observe the pressure dressing is tight, clean and no signs of bleeding to prevent infection.

CONTD…

Observe the client until their condition stable and recover.

Monitor vital signs after the procedure.

POSSIBLE COMPLICATION

• Infection

• bleeding