40

SKILL 14 Assisting with Child during Bone Marrow

Aspiration and Biopsy
EQUIPMENT 1. Steps 1–5 of General Guidelines.
Bone marrow aspiration tray: 2. Premedicate per physician’s order. Reduces discomfort
Antiseptic solution during the procedure.
Sterile drape
3. Wash hands. Reduces transmission of microorganisms.
Gauze sponges
Sterile syringes, various sizes 4. Set up tray, open supplies for physician.
Needles, 23–25 gauge 5. Position child according to site of aspiration. (Site deter-
Bone marrow needle mined by physician.) (Figure 14)
Gloves, sterile (physician) a. Anterior iliac crest lateral recumbent or supine.
Gloves, nonsterile (nurse) b. Posterior iliac crest prone or lateral recumbent with
Local anesthetic head flexed and knees drawn up to abdomen.
Test tubes or glass slides c. Distal third of thigh supine with sandbag underneath.
Gauze d. Sternum supine with small pillow beneath shoulders.
Tape Arms at sides, feet together. Elevates chest and low-
Antiseptic ointment ers head.
Mask and goggles (physician and nurse per agency policy) e. Tibia supine with sandbag under proximal third of
lower leg.
GENERAL GUIDELINES FOR DIAGNOSTIC f. Vertebral process prone with feet together and arms
TESTS at side.
1. Explain procedure to child and family. Enhances cooper- 6. Restrain child as necessary.
ation and participation and reduces anxiety and fear. 7. Physician will cleanse site, drape, infiltrate area with
2. Obtain signed consent. local anesthetic and obtain specimen using sterile tech-
nique.
3. Gather equipment. Promotes organization and effi-
ciency. 8. Hold pressure on puncture site for 5–15 minutes.
Prevents bleeding and hematoma formation, especially if
4. If possible, have child void before procedure. Promotes
child thrombocytopenic.
comfort and avoids interruption of procedure.
5. Wash hands. Reduces transmission of microorganisms.

FIGURE 14 Common sites used for bone marrow aspiration.

PROCEDURE continued
Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.
 41

SKILL 14 Assisting with Child during Bone Marrow

Aspiration and Biopsy continued
9. Cover puncture site with sterile pressure dressing. DOCUMENTATION
Protects site. 1. Bone marrow aspiration performed, site, time, physi-
10. Help child to comfortable position. cian’s name.
11. Put on nonsterile gloves. 2. How procedure tolerated.
12. Label specimens and place in appropriate bag or con- 3. Specimens obtained and sent.
tainer along with laboratory requisition slips. Ensures 4. Vital signs, pain, bleeding, drainage.
specimen properly identified and appropriate test per-
5. Type of dressing over puncture site.
formed.
13. Dispose of equipment in appropriate container.
Consistent with body fluid precautions.
14. Remove gloves. Wash hands. Reduces transmission of
microorganisms.
15. Send specimen to lab.
16. Monitor child for complications according to agency
policy. Check for hemorrhage and infection.
a. Vital signs may be checked as often as every 15 min-
utes for 2 hours.
b. Observe puncture site for drainage, edema, and pain.

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.