Bone marrow Aspiration and Biopsy Procedure explained

Summary

This video demonstrates the procedure for performing bone marrow aspiration and biopsy from the posterior iliac crest, a crucial method for diagnosing hematologic abnormalities, metastatic cancers, and metabolic disorders. It covers the necessary preparation, equipment, and sterile techniques, including local anesthesia administration and patient positioning. The step-by-step process shows how to properly aspirate marrow, assess the specimen, and perform a biopsy using specialized needles. Afterward, the video details post-procedure care and potential complications, ensuring proper follow-up and patient comfort.

Takeaways

• 😀 Bone marrow aspiration and biopsy are crucial for diagnosing hematologic abnormalities, metastatic cancers, and metabolic disorders.
• 😀 Ensure all necessary equipment is prepared, including sterile materials and lidocaine for anesthesia, prior to starting the procedure.
• 😀 Bone marrow aspiration and biopsy should not be performed if there is suspicion of bone infection.
• 😀 The posterior iliac crest is the most common site for the procedure, but the anterior iliac crest or sternum may be used in certain cases.
• 😀 Position the patient in a lateral decubitus position with knees flexed to access the posterior iliac crest for the procedure.
• 😀 Sterile preparation of the site with chlorhexidine scrub and sterile draping is essential to minimize infection risk.
• 😀 Local or systemic analgesia may be necessary for pain management during the procedure, especially for pediatric patients who require deeper sedation.
• 😀 Lidocaine should be used to anesthetize the area, and its effectiveness should be checked by gently tapping the periosteum.
• 😀 During aspiration, the needle should be rotated while applying pressure until the marrow cavity is accessed, at which point a sudden decrease in resistance is felt.
• 😀 Bone marrow biopsy is typically performed following aspiration, using a slightly different angle to retrieve a biopsy specimen from the marrow cavity.
• 😀 After the biopsy, the specimen should be carefully removed from the needle by rotating it and pushing it onto sterile gauze or a slide for inspection.

Q & A

What is the primary purpose of bone marrow aspiration and biopsy?

Bone marrow aspiration and biopsy are performed to evaluate hematologic abnormalities, diagnose metastatic spread of non-hematologic malignancies, and diagnose metabolic disorders.

What equipment is required for performing a bone marrow aspiration and biopsy?

The equipment required includes sterile skin preparation materials, 1% lidocaine buffered with sterile sodium bicarbonate, a 25-gauge needle, a 5-milliliter syringe, bone marrow aspiration and biopsy needles, 30-milliliter syringes, sterile heparin sulfate, sterile gauze, and bandages.

Why should a sterile field and strict sterile precautions be maintained during the procedure?

Maintaining a sterile field and strict sterile precautions minimizes the risk of infection, which is crucial for the safety and success of the procedure.

What is the most common site for bone marrow aspiration?

The most common site for bone marrow aspiration is the posterior iliac crest.

What is the recommended patient positioning for performing the procedure?

The patient should be positioned in the right or left lateral decubitus position with knees flexed to access the posterior iliac crest.

What are some contraindications for performing bone marrow aspiration and biopsy?

Bone marrow aspiration and biopsy should not be performed if an infection of the bone is suspected or if other specific contraindications are present.

What is the role of lidocaine in the procedure?

Lidocaine is used as a local anesthetic to numb the biopsy site and reduce pain during the procedure.

Why is the bone marrow aspiration needle rotated during insertion?

The needle is rotated alternately clockwise and counterclockwise while applying steady pressure to engage the bone and enter the marrow cavity, as this helps overcome the resistance of the bone cortex.

What is the purpose of using heparinized syringes during aspiration?

Heparinized syringes are used to prevent clotting of the bone marrow sample during aspiration, which is necessary for diagnostic tests.

How should a bone marrow biopsy specimen be removed from the needle?

The biopsy specimen should be detached from surrounding marrow and bone by rotating the needle 360 degrees in both directions before slowly removing it from the needle while continuing to rotate to ensure detachment.