سمينار 3

University of kerbala
College of nursing
2022/2023
Bone marrow biopsy and aspirations
Prepare and present by :

Ameer Qahtan Adnan
Fatima Adnan Hajem
Eman Mohammed Abbas ‫أ‬. ‫م‬. ‫قاسم‬
Hussein Ahmed Najem
Introduction
Bone marrow biopsy: The procedure takes a sample of the solid spongy part of
bone marrow.
Bone marrow aspirations: The procedure takes a sample of the liquid part of bone
marrow.
INDICATIONS
1) used to flow cytometry for immune phenotypic analysis, cytogenic studies or

molecular studies.
2) Used to evaluation of haematology conditions.
3) Cancer, metastatic disease.
4) Storage disorders as well as some chronic systemic conditions.

CONTRAINDICATIONS
(1) The risk of anaesthesia or deep sedation.
(2) An active infection at the proposed site of aspiration and biopsy.
(3) Thrombocytopenia and other coaguopathies are not contraindication for the
procedure if it is executed by a skilled clinician.
Site of bone marrow biopsy and aspirations
1. Anterior and posterior iliac crest.
2. The manubrium of sternum.
3. The tibia(in infants).

COMPLICATIONS
1. Trauma to neighbouring structures (eg•lacerations of the glutel artery and soft

tissues).
2. Infection.
3. Haemorrhage, the most commonly reported complications is hemorrhage.
4. Fractures of the underlying bone especially in patients with osteoporosis.
5. Altered mental status that could represent early sign of shock.
6. Swelling
7. Pain.
The position for a bone marrow aspiration or biopsy depends on the chosen site.
In children, the posterior or anterior iliac crest is most frequently used, but in
infants, the tibia may be selected because it is easy to access the site and hold the
child. If the posterior iliac crest is used, the child is positioned prone.
Sometimes a small pillow or folded blanket is placed under the hips to facilitate
obtaining the bone marrow specimen.
Types of needles
1. Klima sternal needle
2. Salah needle
3. Watherfield needle
4. Jamshidi needle.
Assessment and nursing care
Before procedure
1. Identify the child using two patient identifiers (e. g, patient name, and medical
record or birth date; neither can be a room number). Compare the same two
identifiers with the specimen container and order .
2. Explain the procedure to parents and child according to the developmental level
of the child; re assure the child that the procedure is not punishment.
Cont…
3. Determine the ability of the child to stay during the procedure and explain the
importance of doing so .
4. Perform hand hygiene, maintain aseptic technique, and follow standard

precautions .
5. Take vital signs and administer sedatives as ordered .
6. Help him to the appropriate position: lateral decubitus or prone if the insertion
site will be the posterior iliac crest, supine if the sternum or anterior iliac crest
will be used
Assessment and nursing care
After procedure
1. Document pertinent aspects of the procedure, such as number of attempts, site,

and amount of blood withdrawn .
2. Properly label and promptly transport all specimens to the lab .
3. Monitor his vital signs and assess the puncture site for bleeding .
Cont…
4. Assess post procedure pain intensity and provide analgesia as ordered .
5. Don’t administer analgesics containing aspirin .
6. Teach him to watch for signs of infection .
7. Provide a traumatic care and position to the child securely .

Procedure
After local anaesthesia has taken effect, make an incision through which you can
introduce the bone marrow aspiration needle.
In general, the needle should be advanced at an angle completely perpendicular to

the bony prominence of iliac crest. Once the needle passes through the cortex and
enters the marrow cavity, it should stay in place without being held. Once the
periosteum has been penetrated, use pressure to advance the needle through the
cortex.
Cont…
Rotate the needle in a semicircular motion, alternating clockwise movements.
If the patient is in the lateral position, you may stabilise the hip with your other
hand to get a better feel for the position and depth of the needle.
Remove the stylet and aspirate approximately 1ml of un adulterated bone marrow
into a syringe.
Remove the needle, either after re inserting the stylet or with the syringe attached.
Cont…
Apply pressure to obtain adequate hemostasis (this may takes a few minutes, or
longer in a patient with coagulopathy).
Then clean the area with alcohol or another disinfectant.
Place clean or antibiotic-soaked gauze at the incision site, using acoompression

bandage
The bandage may be removed after 24hours
Once the bandage is removed, the area should be monitored for infection or
delayed bleeding
References
• Malempati, S., Joshi, S., Lai, S., Braner, D. A.,&Tegtmeyer, K.(2009). Bone marrow aspiration and biopsy. N Engl J Med ,
361(15), 28.
• Hockenberry, M.&Wilson, D.(2015). Wong’s nursing care of infants and children-E-book. 10th Edition. Elsevier Health
Sciences. Elsevier, Canada.
• GA Hamid 1,N Hanbala, Gulf J Oncolog, 2009 Ju.

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University of kerbala

Bone marrow biopsy and aspirations

Prepare and present by :

1) used to flow cytometry for immune phenotypic analysis, cytogenic studies or

2) Used to evaluation of haematology conditions.

3) Cancer, metastatic disease.

4) Storage disorders as well as some chronic systemic conditions.

(1) The risk of anaesthesia or deep sedation.

(2) An active infection at the proposed site of aspiration and biopsy.

1. Anterior and posterior iliac crest.

2. The manubrium of sternum.

3. The tibia(in infants).

1. Trauma to neighbouring structures (eg•lacerations of the glutel artery and soft

3. Haemorrhage, the most commonly reported complications is hemorrhage.

4. Fractures of the underlying bone especially in patients with osteoporosis.

5. Altered mental status that could represent early sign of shock.

1. Klima sternal needle

4. Perform hand hygiene, maintain aseptic technique, and follow standard

5. Take vital signs and administer sedatives as ordered .

1. Document pertinent aspects of the procedure, such as number of attempts, site,

2. Properly label and promptly transport all specimens to the lab .

4. Assess post procedure pain intensity and provide analgesia as ordered .

5. Don’t administer analgesics containing aspirin .

6. Teach him to watch for signs of infection .

7. Provide a traumatic care and position to the child securely .

In general, the needle should be advanced at an angle completely perpendicular to

Rotate the needle in a semicircular motion, alternating clockwise movements.

Then clean the area with alcohol or another disinfectant.

Place clean or antibiotic-soaked gauze at the incision site, using acoompression

The bandage may be removed after 24hours

• GA Hamid 1,N Hanbala, Gulf J Oncolog, 2009 Ju.

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