1. Select puncture site:
(1) Puncture point of anterior superior iliac spine: located on the iliac crest 1-2cm behind the anterior superior iliac spine;
(2) Puncture point of posterior superior iliac spine: located on both sides of the sacrum and protruding above the buttocks;
(3) Sternum puncture point: the position of the sternum stalk or sternum body equivalent to the intercostal space between the two ribs;
(4) Lumbar spinous process puncture point: located at the origin of the lumbar spinous process.
2. Puncture position: When the sternum and anterior superior iliac spine are the puncture points, take a supine position; When the spinous process is the puncture point, take a sitting or lateral position; When the posterior superior iliac spine is used as the puncture point, the patient should be placed in a lateral position.
3. Wear sterile gloves before surgery, disinfect the local skin regularly, cover with sterile gauze, and use 2% lidocaine for local skin, subcutaneous, and periosteal anesthesia.
4. Fix the bone marrow puncture needle fixator at an appropriate length position (approximately 1 Ocm for sternum puncture and 1.5 cm for iliac puncture). After surgery, fix the puncture site with the left thumb and index finger, and insert the needle vertically into the bone surface with the right hand (when puncturing the sternum, the needle body should be kept at a 30 ° -40 ° angle to the sternum). After the needle tip contacts the bone, rotate the needle body left and right and slowly drill. When the resistance is felt to disappear and the puncture needle is fixed in the bone, it indicates that the needle tip has entered the medullary cavity.
5. Pull out the needle core, place it in a sterile tray, connect a 10ml or 20ml sterile dry syringe, and use appropriate force to aspirate an appropriate amount of bone marrow fluid for testing (first, 0.1-0.2ml should be aspirated for preparing bone marrow smears; If bone marrow bacterial culture or hematopoietic stem cell culture is required, 1-2ml of bone marrow fluid should be aspirated for testing after preparing the bone marrow smear.
6. The extracted bone marrow droplets are quickly counted for nucleated cells on a glass slide and several smears are prepared.
7. If the bone marrow fluid cannot be extracted, the needle core should be inserted again, the needle body should be rotated slightly, or a small amount should be drilled in or withdrawn, the needle core should be removed, and suction should be performed again. If bone marrow fluid cannot be extracted, consideration should be given to changing the site of puncture or performing bone marrow biopsy.
8. After suction, insert the needle core. Place sterile gauze on the needle hole with your left hand, pull out the puncture needle with your right hand, then cover the needle hole with gauze and press for a few minutes, then use adhesive tape to press and fix the gauze.
