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.
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