Definition
Bone marrow aspiration and biopsy are medical procedures used to collect and examine bone marrow, the spongy tissue inside certain bones that produces blood cells.
Bone Marrow Biopsy: This procedure uses a special needle to remove a small piece of solid bone marrow tissue. It is often done alongside aspiration to provide a more comprehensive analysis of the bone marrow’s structure and function.
Bone Marrow Aspiration: This involves using a thin needle to withdraw a small sample of the liquid portion of the bone marrow. It is typically performed to evaluate blood cell production or detect abnormalities.
Purposes
- To diagnose hematological disorders.
- To follow the course of disease and patient’s response to treatment.
- To diagnose diseases, such as primary metastatic tumors, infectious diseases and certain granulomas.
- To isolate bacteria and other pathogens by culture.
Articles
A trolley with the following:
- 5 cc syringe.
- Needles (No. 22, 20).
- Sterile gloves.
- Lignocaine 2%.
- Small bottle with formalin, alcohol, and acetic acid (FAA) solution.
- Culture tubes.
- Slides.
- Mackintosh and draw sheet.
- Razor set.
- Adhesive tape and scissors.
- Tincture benzoin solution.
- Kidney tray.
Sterile pack containing the following:
- Towels.
- Dissecting forceps.
- Cups with cotton balls and gauze pieces.
- Scalpel blade and handle.
- Artery forceps (No. 2).
- 20 cc glass syringe.
- Bone marrow aspiration needle.
- Sterile drapes.
Contraindications
Absolute Contraindications
- Active Infection at the Site:
- If there is an active infection or cellulitis at the proposed biopsy site (e.g., posterior iliac crest), the procedure should be avoided to prevent the spread of infection.
Relative Contraindications
- Severe Bleeding Disorders:
- Patients with significant coagulopathies or thrombocytopenia may be at higher risk of bleeding. However, the procedure can still be performed with precautions, such as platelet transfusion or prolonged pressure at the site.
- Severe Osteoporosis or Bone Fragility:
- In conditions where bones are extremely fragile, there is a risk of fracture during the procedure.
- Unstable Patient Condition:
- Critically ill patients may not tolerate the procedure well unless it is deemed absolutely necessary.
- Patient Refusal:
- If the patient does not consent to the procedure, it cannot be performed.
Procedure
| Nursing action | Rationale | |
| 1. | Check the physician order and nursing care plan and investigation reports, such as coagulation studies. | Obtains specific information/instructions. |
| 2. | Ascertain that consent has been duly signed and fully understood by the patient. | Fulfills legal requirements and hospital policies. |
| 3. | Identify the patient. | Ensures performance of right procedure on right patient. |
| 4. | Explain procedure to the patient and ensure that pain medication is given. | Allays fear and gains patient’s confidence and cooperation. |
| 5. | Collect and assemble equipment. | |
| 6. | Ensure privacy. Shave the site, if necessary. | Avoids unnecessary embarrassment to the patient during the procedure. |
| 7. | Help patient into correct position: Supine for sternal puncture. Lateral position with upper knee flexed for iliac crest puncture. | |
| 8. | Open small dressing pack and put sterile slide, syringes, needle, and scalpel blade into pack. | |
| 9. | Assist physician to clean the site with solution and drape with sterile towels. | Reduces risk of infection. |
| 10. | Inform patient, that anesthetic will be injected and the site infiltrated. | Prepares patient to anticipate what he will be experiencing. |
| 11. | Continue to observe and reassure the patient as the physician punctures and aspirates the marrow. | |
| 12. | Receive the syringe with bone marrow and collect specimen in various containers as indicated. | Bone marrow tissue is collected in containers with formalin, acetic acid, and alcohol (FAA) solution. |
| 13. | Once the physician removes the needle, apply pressure over puncture site for 5-10 minutes using a sterile topical swab until the bleeding stops. | Minimizes bleeding and hematoma formation. Prolonged pressure, i.e. 5-10 minutes of pressure, is required if the patient has low platelet count (thrombocytopenia). |
| 14. | When bleeding stops, seal puncture site with tincture benzoin and apply small, firm dressing. | Avoids chances of oozing from puncture site. |
| 15. | Instruct patient not to wash or wet the area for 24 hours. | Provides an airtight seal over the puncture site and prevents entry of bacteria. |
| 16. | Make the patient comfortable. Instruct the patient that he or she may be mobile after 4-6 hours. | |
| 17. | Remove and dispose off waste, wash and replace reusable articles. | |
| 18. | Send specimen to laboratory with necessary data in the form and container properly labeled. | |
| 19. | Record information in patient’s chart including patient’s tolerance and condition. |
Post procedural care
- Keep patient in supine or lateral position.
- Administer analgesics, if required.
- Monitor pulse and respiration every 30 minutes for 4-6 hours or until stable.
Complications
- Bleeding.
- Infection.
Special considerations
- Aspirin containing analgesics should be avoided as these may cause bleeding.
- Apply prolonged pressure to the biopsy site to minimize bleeding risks.
- Offer emotional support and, if necessary, sedation to reduce stress.
- Record the procedure details, including the site, type of sample collected, and any complications.
Pediatric variation
- The site for biopsy for children below 2 years is tibia.
- Children need to be sedated before aspiration.
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 Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- 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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