Bone marrow aspiration


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Bone marrow aspiration

  1. 1. Is a procedure performed by the doctor where a special needle is inserted into the bone marrow to obtain bone marrow tissue specimen.
  2. 2.  Erythrocytes  Leukocytes  Thrombocytes
  3. 3.  To diagnosis/ staging of diseases  Leukemia  Multiple myeloma  Lymphoma  Anemia  Thrombocytopenia  Pancytopenia  To monitor the development of hemolytic disease and respond towards the treatment given.  To obtain more information on hematopoiesis.
  4. 4.  Haematological disorder  Fever Unknown Origin (FUO)  Lymphadenopathy  Hepatosplenomegaly  Metastatic tumour  Tuberculosis
  5. 5.  Iliac Crest ( posterial and superior part, client lie on lateral or prone position)  Sternum (2nd space of sternum)  Tibia Crest ( babies below 1 year)
  6. 6.  Infection  Bleeding
  7. 7.  Bleeding disorders  Infection of the skin overlying the area from which the biopsy is to be taken  Infection in the bloodstream  Severe osteoporosis
  8. 8.  Check doctor’s order in progress note:  Right client  Selected site for procedure  Any pre-medication order Check for consent form is sign by doctor and client.  Assess client’s: Lever of consciousness or restless Ability to assume position required for procedure.
  9. 9.  Skin of procedure site  Vital sign Notify for lab Technician on call  Prepare environment
  10. 10.  Second nurse as assistant  Lab technician with glass slide
  11. 11.  Carbolised tray  Big tray with: • Disposable dressing set • Extra cotton balls and gauzes • 1 pair of sterile gloves • Face mask • 1 Fenestrated towel • Bone marrow aspiration needle with inner stylet •Cleansing solution (surgiacal spirit 70% and Povidone.
  12. 12. • Lignocaine 1% or 2% • Syringes: 3ml×2, 5ml×2 and 20ml×2 • Needles: 18G×2 and 23G×2 • Heparin saline 5ml×2 • Elastoplast • Medication tray with prepared pre-medication drugs. Laboratory form according to type of test.
  13. 13. Wash hand. Greet client and check ID tag. Explain procedure. Provide privacy. Adjust bed. Second nurse position client according to doctor’s chosen site for procedure. Expose insertion site and place incopad underneath.
  14. 14. 1st nurse assist the doctor throughout procedure: • open dressing set follow by all sterile items as per requirement needs. • Pour solution • Give assistant to doctor when necessary 2nd nurse observe client’s condition for difficulty in breathing or unbearable pain throughout the procedure.  Maintain client in supine position and check client’s vital sign hourly for 4 hours.
  15. 15. Make client comfort.  Put up both cot side and place call bell within the client’s reach. Cleat trolley and wash hands.  Document in nursing care plan.
  16. 16.  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.
  17. 17.  Prepare equipments •Prepare trolley aseptically •Make sure equipments are complete Make sure laboratory technicians has been inform more earlier.( Technician must be present during procedure because aspirated bone marrow is smeared immediately on a glass slide.)
  18. 18.  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.
  19. 19.  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.  Observe the client until their condition stable and recover. Monitor vital signs after the procedure.
  20. 20.  Tidy the equipment and make sure CSSD instruments are complete before sending to autoclave.