Prepare and Assist inBone Marrow Examination

Clinical Instructed: Pn. Haida

Presented By: Komathi.r ,Dineswari

SIME DARBY NURSING AND HEALTH SCIENCE COLLEGE

DEFINITION

Is a procedure performed by the doctor where

a special needle is inserted into the bone

marrow to obtain bone marrow tissue

specimen.

CELL WHICH ARE STUDIED:

Erythrocytes

Leukocytes

Thrombocytes

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.

INDICATION

Haematological disorder

Fever Unknown Origin (FUO)

Lymphadenopathy

Hepatosplenomegaly

Metastatic tumour

Tuberculosis

TYPE OF BONE MARROW NEEDLE

Klima needle

Jamshidi Needle

COMMON LOCATIONS

Iliac Crest ( posterial and superior part,

client lie on lateral or prone position)

Sternum (2nd space of sternum)

Tibia Crest ( babies below 1 year)

POSIBLE COMPLECATION

Infection

Bleeding

RISK FACTORS FORCOMPLECATION

Bleeding disorders

Infection of the skin overlying the area from

which the biopsy is to be taken

Infection in the bloodstream

Severe osteoporosis

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.

Skin of procedure site

Vital sign

Notify for lab Technician on call

Prepare environment

PREPARATION

Second nurse as assistant

Lab technician with glass slide

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.

• 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.

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.

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.

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.

NURSING RESPONSIBILITY

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.

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.)

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.

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.

Tidy the equipment and make sure CSSD

instruments are complete before sending to

autoclave.