PROCEDURE 118 • A thorough understanding is needed of the anatomy and physiology of the posterior and anterior iliac crest and the sternum. The preferred site for a bone marrow aspirate and biopsy is the posterior iliac crest.1 The sternum may be used to aspirate marrow; however, a core biopsy cannot be obtained from the sternum because of risk of damage to underlying organs, most significantly the heart.6,8 • Clinical and technical competence in assisting with a bone marrow aspirate and biopsy is necessary. • Clinical and technical competence in preparing slides and caring for a core biopsy is needed. • Knowledge of sterile technique is necessary. • Understanding is needed of institutional policies and procedures for administration of and monitoring of intravenous (IV) and oral pharmacologic agents, including conscious sedation (if indicated). • Procedural care of the patient receiving IV conscious sedation or oral antianxiolytics or pain medication should be understood. • Bone marrow aspirate is used in identification of normal and abnormal hematopoietic elements. The aspirate is also used to identify malignant clones with flow cytometry, to identify chromosomal abnormalities that occur in hematologic malignant disease, to perform molecular diagnostic studies of gene rearrangements and translocations, and to perform chimerism studies in patients after allogeniec transplant. • The bone marrow biopsy is used for morphologic analysis of hematopoietic cells and for assessment of the architecture of the bone marrow that may be abnormal in certain disease states. • Indications for bone marrow aspiration and biopsy include the following: • Contraindications to bone marrow biopsy and aspirate are the presence of hemophilia, severe disseminated intravascular coagulopathy, or other related severe bleeding disorders. Thrombocytopenia alone is not a contraindication to bone marrow examination.3,5 The use of anticoagulant medications may pose serious bleeding risk; therefore, coagulation studies should be obtained in these patients. The decision on whether anticoagulation can be safely withheld prior to and restarted after the procedure is patient dependent. • Bone marrow aspiration and biopsy kit, which includes the following: • Filtered needle (if lidocaine drawn from glass vial) • Fluid shield face mask or goggles • Required tubes for specimen processing: two EDTA (lavender top) and two sodium heparin (green top) tubes (follow institution standard)
Bone Marrow Biopsy and Aspiration (Assist)
PREREQUISITE NURSING KNOWLEDGE
To diagnosis a hematologic abnormality
To monitor a hematologic disease state after initial diagnosis or therapy
To assess the status of disease after autologous bone marrow or hematopoietic stem cell transplant
To evaluate immunodeficiency syndromes or to confirm an infectious disease process in the marrow
EQUIPMENT
Povidone-iodine or chlorhexidine-alcohol antiseptic preparation
1 vial of lidocaine (1% or 2%; 5-10 mL)
5 or 10-mL syringe for drawing up lidocaine
Needles of appropriate lengths to anesthetize both skin and periosteum
Sterile 4 × 4 and 2 × 2 gauze pads
Bone marrow aspirate needle (Illinois needle)
Jamshidi bone biopsy needle (regular or extra long)
20-mL syringe for bone marrow aspirate
10-mL syringes for marrow aspiration
Edetate disodium (EDTA) sterile solution (15 mg/mL; 2 mL total)
Blunt needles for drawing up EDTA, heparin, saline solution
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118: Bone Marrow Biopsy and Aspiration (Assist)
