LU 1 : Nursing care of patient with bone marrow aspiration

What is bone marrow aspiration ?

• It is a procedure performed by the doctor where a special needle is inserted into the bone marrow to obtain bone marrow tissue specimen

What is aspiration and biopsy ?

• Aspiration : i) primarily utilized for cytologic assessment ii) performed before marrow biopsy

• Biopsy : allow optimal evaluation of bone marrow cellularity, fibrosis, infections

What are the purpose of bone marrow aspiration ?

• To diagnose / staging of disease such as leukemia, tuberculosis

• To monitor the development of haemolytic disease and respond toward the treatment given

• To obtain more information on haemotopoiesis

What are the types of bone marrow needle ?

• Klima needle

• Jamshidi needle : longer can be used for both aspiration and biopsy from iliac crest

What are the common location for bone marrow aspiration ?

• Iliac crest i. Posterior superior - For safety, decreased risk of pain, and accessibility - Patient lie on lateral or prone position ii. Anterior superior - as a result of infection, injury, or obesity

• Sternum (2nd space of sternum)

• Tibia crest (baby below 1 year)

What are the possible complications of bone marrow aspiration ?

• Bleeding

• Haematoma

• Pain

• Infection

• Penetration to the nearest organ

• Reaction from sedation e.g. drowsy, allergy

What are the types laboratory form according to type of test ?

• Request form for bone marrow examination

• Bone marrow cytogenetics

• Molecular analysis for Leukemia

• Hematology Lab requisition

• Borang PER-PAT 301 Kementerian Kesihatan Malaysia

What are the nursing responsibilities before bone marrow aspiration procedure ?

1. Check doctor’s order in progress note

2. Check for consent form is sign

3. Assess patient’s vital sign etc

4. Make sure laboratory technician has been inform more earlier

5. Prepare environment-privacy, spacious

6. Prepare equipment

What are the nurse’s role during the procedure ?

• 1st nurse : assists the doctor throughout the procedure

• 2nd nurse : observes patient’s condition

What are the specimen needed for bone marrow aspiration ?

• Smear- microscope slide

• Trephine- container with formalin solution

• Cytogenetic- Sodium heparin tube

• Molecular- EDTA tube

What are the nursing responsibilities after bone marrow aspiration procedure ?

1. Apply pressure dressing at the puncture site for at least 6 hours to prevent bleeding

2. Place the patient in supine position for 1-2 hours

3. Monitor vital sign after the procedure

4. Document the procedure

5. Observe the pressure dressing is tight, clean and no signs of bleeding

6. Observe the patient until condition is stable and recover

7. Tidy the equipment