Bone marrow aspiration in pediatrics is an invasive diagnostic procedure used to obtain a sample of the liquid portion of bone marrow for evaluation. It plays a crucial role in diagnosing hematologic malignancies, aplastic anemia, bone marrow suppression, and infections that may reside in the marrow.
Indications
- For diagnosis of malignant cells
- To diagnose aplastic anaemia and bone marrow suppression.
Sites for Bone Marrow Aspiration
- Children younger than 2 years: A point on the anterior-medial aspect of tibia about
- 2.5 cm below the tibial tubercle.
- Older children: Posterior or anterior iliac spine
Note: Sternum is usually avoided in children P because the bone is more fragile and adjacent to vital organs.
Position
- 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.
- In the case of anterior iliac crest, supine position is used.
Equipment Needed for Bone Marrow Aspiration
A sterile tray containing:
- Pair of sterile gloves
- Trocar and cannula (pediatric size)
- 20-mL syringe
- Center hole towel
- 1% procaine or xylocaine injection
- Syringe and needle
- Povidone iodine solution in a bowl
- Sterile gauze pieces
- Pressure bandage
- Sponge holder
- Dustbin at the foot end of the procedure table
- Specimen bottles/containers/8-10 glass slides
Preparation of Child and Parents
- Bone marrow aspiration is one of the most painful procedures. Adequate explanation should be given to parents and child as appropriate.
- Obtain a written consent.
- Sedation should be given to the child to reduce the pain and anxiety.
- Most sedation protocols combine opioid analgesics with benzodiazepine for anxiolysis and sedation. Sedation is induced with agents, such as ketamine, propofol, and methohexital.
Procedure
- Perform surgical scrub.
- Don gloves.
- Position the child appropriate to the site selected.
- Paint the area with antiseptic wipes.
- Infiltrate the skin with procaine 1% up to the periosteum.
- Place the center hole towel over the site.
- Insert the trocar and cannula with rotating action through the skin down to the periosteum and then through the cortex into the marrow cavity.
- As soon as the needle enters the cavity, some “give” is felt and there is sudden lack of resistance.
- With the needle firmly fixed in situ, trocar is removed.
- A fleck of marrow on the tip of the trocar confirms that the needle is in the marrow cavity.
- Fit a dry 20-mL syringe to the needle.
- With strong suction for a few seconds, about 0.2 mL of marrow is aspirated into the syringe.
- After aspiration, trocar is replaced and the needle withdrawn.
- The puncture site is pressed with a finger for 3-5 minutes.
- A sterile dressing is applied over the site.
- The aspirate is smeared in equal amounts on 8-10 glass slides, which are waved in the air to accomplish fast drying.
Post procedure Care
- Apply a small pressure bandage over the puncture site.
- No activity restriction is necessary after the bone marrow test, although the site is usually sore, and the child may prefer to remain quiet.
- Send the specimens to the laboratory with the request form for diagnosis.
- Document the procedure on nursing chart with date and time, approach used, and site selection.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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