ASSISTING BONE MARROW ASPIRATION

Objectives:
At the end of the 5-hour reporting and discussion, the level III nursing students
will be able to:
1. Define the following terms
● Bone Marrow Aspiration
● BoneMarrow
● Biopsy
● Fibrosis
● Hematoma
● Hematopoiesis
● Hemorrhage
2. Anatomy and Physiology of the Bone Marrow in relation to Hematopoiesis
3. Differentiate the Normal and Abnormal Characteristics of the Bone Marrow
4. Discuss the Purpose of Bone Marrow Aspiration
5. Enumerate the Indications and Contraindications of Bone Marrow Aspiration
6. Locate the sites of Bone Marrow Aspiration
7. Relate the Principles involved in Bone Marrow Aspiration
8. Explain the essential Guidelines in Bone Marrow Aspiration
9. Identify the Nursing Responsibilities Before, During, and After Bone Marrow
Aspiration
10.Demonstrate Beginning Skills in Assisting the Physician during Bone Marrow
Aspiration

1. Define the following terms:

1.1. Bone Marrow Aspiration
- Is the withdrawal of fluid that has abnormally collected in the bone
marrow.
1.2. Bone Marrow
- Is the site of hematopoiesis or blood cell formation.
1.3. Biopsy
- Is the removal and examination of tissue and are usually performed to
determine a diagnosis or to detect malignancy. This is an invasive
procedure and requires strict sterile technique.
1.4. Fibrosis
- Also known as scarring; a factor that causes marrow destruction
1.5. Hematoma
- Are collections of blood in the brain that may be epidural, subdural, or
intracerebral.
1.6. Hematopoiesis
 - A complex process of the formation and maturation of blood cells
1.7. Hemorrhage
- Or also known as bleeding, Is an uncommon yet serious complication
of surgery that can result in hypovolemic shock and death.

2. Anatomy and Physiology of the Bone Marrow in relation to Hematopoiesis

3. Differentiate the Normal and Abnormal Characteristics of the Bone Marrow

Normal:
● Marrow may appear red or yellow
● It is highly vascular
● Semifluid state
● Specimen shows grossly visible bone spicules
● Can be aspirated through a special large needle

4. Discuss the Purpose of Bone Marrow Aspiration

● Early detection of a tumor within the marrow
● To determine diagnosis
● To assess how a patient’s blood cells are being formed
● To assess the quantity and quality of each type of cell produced
● To document infection or tumor within the marrow
● To further identify certain malignant conditions
● To establish a prognosis

5. Enumerate the Indications and Contraindications of Bone Marrow Aspiration

Indication of Bone Marrow Aspiration:
 Indications:
● Unexplained anemia
● Unresolved neutropenia after withdrawal from antibiotic therapy
● Suspected metastatic disease
● Abnormal hematopoietic disorder(leukemia, idiopathic
thrombocytopenia, pancytopenia)
● Lymphoproliferative disorders, including lymphoma
● Immunodeficiency disorders, including HIV
● Fever of unknown etiology
● Suspected unusual presentation of an infectious disorder (fungal,
tuberculosis)
● Chromosomal analysis
● Bone marrow transplantation

Contraindications:
● Patient cannot maintain position during procedure
● Severe osteoporosis
● Hemophilia
● Known radiation to bone site

6. Locate the sites of Bone Marrow Aspiration

Adult
- Posterior Superior Iliac Crests (Prone or Lateral Recumbent Position)
- Sternum (Supine Position)
Children
- Posterior Superior Iliac Crests (Prone or Lateral Recumbent Position)
Infant
- Proximal Tibia

7. Relate the Principles involved in Bone Marrow Aspiration

Anatomy and Physiology
Nurses need to know anatomy and physiology in order to learn how to
care for their patients. The body must be in a balanced state in order to
function. In other words, nurses must learn Anatomy and Physiology in order
to help their patients understand why they are unwell and assist in treatments
such as bone marrow aspiration.

Body Mechanics
Body mechanics is the use of the body in a safe manner to bend, carry,
lift, and move objects and people while maintaining proper posture, alignment,
 balance, and motions. Both the patient and the nurse are protected by proper
patient handling and the application of body mechanics.

Pharmacology
Nurses are important in the administration of medication to patients,
which they may administer as frequently as every few minutes depending on
the context in which they work. As a result, nurses must be knowledgeable
about pharmacology and potentially lethal drug interactions, especially when
these medications are used in procedures.

Microbiology
In many aspects of health care, a nurse's expertise of microbiology is
important.Nurses should be familiar with how infections spread. This
information would assist a nurse in looking for specific infection control
measures, especially in lowering potential hazards during medical
procedures. Nurses are also important in immunizing people against a variety
of diseases.

8. Explain the essential Guidelines in Bone Marrow Aspiration

● Inform the client of the plan and approximate time for the bone marrow
aspiration. Allow time to answer questions
● Witness the client’s signature on a consent form for the procedure as
well as for conscious sedation.
● Check the client’s medical record for history of allergies, especially to
local anesthetics or latex, and the results of coagulation studies that
may have been performed.
● Obtain a sterile bone marrow aspiration tray and the type and strength
of local anesthetic according to the physician’s orders.
● Determine the site from which the physician intends to obtain the
sample of bone marrow, for example, iliac crest or sternum.
● Attach a pulse oximeter to the client’s finger to monitor oxygenation
that may be compromised when conscious sedation is used.
● Position the client on his or her back or side to facilitate access to the
aspiration site.
● Cleanse, clip hair, and drape the skin at the test site.
● Suggest distraction techniques to avoid focusing on the pressure or
discomfort associated with puncturing the bone that may take
approximately 20 minutes.
● Administer analgesia for significant discomfort
● Be prepared to place sample of the aspirate on slides and allow them
to dry
● Label the biopsy specimen in preservative and ensure its delivery to the
laboratory
 ● Follow standard precautions when there is a potential for contact with
blood from the client, equipment, and bedside environment
● Apply direct pressure followed by a pressure dressing to the site after
the needle has been withdrawn
● Instruct the client to lie on the site for at least 10 minutes or longer
● Limit the client’s activity for approximately 30 minutes after the
procedure
● Monitor the puncture site frequently for continued bleeding; change or
reinforce the dressing as needed
● Report prolonged bleeding, unusual pain at the site that is unrelieved by
analgesics, fever, and other signs of an infection such as swelling and
purulent drainage
● Delay bathing or showering for 24 hours
9. Identify the Nursing Responsibilities Before, During, and After Bone Marrow
Aspiration
Before:
● Verify type of procedure scheduled, purpose, and procedure site with
patient and medical record.
● Verify that informed consent was obtained before administering any
analgesia or antianxiety agents.
● Review medical record for contraindications
● Determine patient’s ability to assume position required for procedure
and ability to remain still. Discuss with health care provider need for
premedication for anxious patients.
● Before procedure: obtain vital signs, oxygen saturation (SpO2)/ end-
tidal measurement. (use ink pen to mark measurement location for
abdominal girth measurement.)
● Instruct patient to empty bladder
● Assess patient’s coagulation status: use of anticoagulant, complete
blood count (CBC), platelet count, clotting factors, activated partial
thromboplastin time (aPTT), international normalized ratio (INR), and
prothrombin time (PT).
● Determine whether patient is allergic to antiseptic, latex, or anesthetic
solutions
● Assess patient’s level of understanding of procedure, including any
concerns.
● Assess baseline pain level, using scale 0 to 10.

During:
● Identify patient using two identifiers (i.e., name and birthday or name
and account number) according to agency policy. Compare identifiers
with information in patient’s identification bracelet
● Perform hand hygiene.
 ● Set up sterile tray or open supplies to make accessible for health care
provider.
● Take “Time-Out”to verify patient’s name, type of procedure scheduled,
and procedure site with patient and health care team.
● Help patient maintain correct position. Reassure patient while
explaining procedure.
○ Adults: for sternal biopsy place in supine position. For iliac crest
biopsy place in prone or lateral recumbent position
○ Children: for iliac crest biopsy place in prone or lateral
recumbent position
● Explain to patient that pain may occur when lidocaine (local anesthetic)
is injected into tissues. Pressure may also occur when tissue or fluid is
aspirated.
● Nurse assesses patient’s condition during procedure, including
respiratory status, vital signs if indicated, and any complaints of pain.
● Note characteristics of aspirate.
● Properly label specimens in presence of patient and transport to
laboratory in proper containers. Label specimen in order of collection.
● If necessary, help with direct pressure and application of gauze
dressing.
● Remove protective equipment, discard in appropriate receptacle, and
perform hand hygiene.

After:
● Monitor level of consciousness, vital signs, and (SpO2)/ end-tidal CO2.
check agency policy; sometimes vital signs are obtained every minutes
for 2 hours.
● Inspect dressing over puncture site for bleeding, swelling, tenderness,
and erythema. Inspect area under patient for bleeding. Avoid disrupting
healing clot at site if pressure dressing is present.
● Evaluate pain score to determine if patient’s level of comfort is
equivalent to a score of 4 or less on pain scale of 0 to 10.

10. Materials
● Spinal needle
● 10cc syringe
● 5cc syringe
● 3 bottles (specimen label 1,2,3)
● Lidocaine
● Eyesheet

11.Demonstrate Beginning Skills in Assisting the Physician during Bone Marrow

Aspiration