Bone marrow aspiration

1. Prepare and Assist in Bone Marrow Exa mination Clinical Instructed: Pn . Haida Presented By : Komathi.r ,Dineswari SIME DARBY NURSING AND HEALTH SCIENCE COLLEGE

2. Definition Is a procedure performed by the doctor where a special needle is inserted into the bone marrow to obtain bone marrow tissue specimen.

3. Cell which are studied: Erythrocytes Leukocytes Thrombocytes

4. Purpose 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 .

5. INDICATION Haematological disorder Fever Unknown Origin (FUO) Lymphadenopathy Hepatosplenomegaly Metastatic tumour Tuberculosis

6. Type of bone marrow needle Klima needle Jamshidi Needle

7. Common Locations Iliac Crest ( posterial and superior part, client lie on lateral or prone position) Sternum (2 nd space of sternum) Tibia Crest ( babies below 1 year)

8. POSIBLE COMPLECATION Infection Bleeding

9. Risk Factors for COMPLECATION Bleeding disorders Infection of the skin overlying the area from which the biopsy is to be taken Infection in the bloodstream Severe osteoporosis

10. Assessment 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.

11. Skin of procedure site Vital sign Notify for lab Technician on call Prepare environment

12. Preparation Second nurse as assistant Lab technician with glass slide

13. Equipments 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 .

14. 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.

15. Implementation 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.

16. 1 st 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 2 nd 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.

17. 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.

18. Nursing Responsibility

19. Before 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.

20. 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.)

21. During 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.

22. After 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.

23. Tidy the equipment and make sure CSSD instruments are complete before sending to autoclave.