1. Nursing Instruction
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【Major points】
  1. The purpose of aspiration of bone marrow were ascertained the function of the bone marrow as a basis for diagnosis and treatment.
  2. If choose general anesthesia must fast for 8 hours.
  3. Patient must lie in supine position for 1-2 hours after examination, and pressurize the puncture wound until there is no bleeding.
  4. The wound should not be exposed to water within 24 hours after the examination to prevent inflammation.
  5. The patient may feel sore after examination, but if the pain becomes unbearable, please notify the medical staff immediately.
 
What is the purpose of bone marrow aspiration and biopsy?
Collection of bone marrow tissue for pathological, chromosomal or genetic examination in order to ascertain the hematopoietic function and cell types of the bone marrow as a basis for diagnosis and treatment.
 
 
Pre-examination Preparations: 
  1. The physician will explain the purpose, steps and precautions of the procedure for patient and their family.
  2. Examination / Anesthesia Consent Forms will to be completed by a legal guardian.
  3. If choose a general anesthesia you must fast for 8 hours to avoid aspiration pneumonia caused by vomiting.
  4. Patient should be assisted to empty the bladder completely prior to examination. Please empty the foley bag when the patient has a urinary catheter in place.
 
Post-procedure Care:
  1. The post-examination posture shown in Figure 1:
    1. Patient must lie in supine position for 1-2 hours after examination.
    2. Pressurize the puncture wound until there is no bleeding. If the wound is bleeding, please notify medical staff immediately. 
    3. If patient were under general anesthesia during the examination, the head must be turned to one side to prevent inhalation of vomit.
  2. When patient awake, a small amount of water can be given first. The patient can resume a normal diet when there is no vomiting or coughing after drinking water.
  3. The puncture wound care:
    1. The wound should not be exposed to water within 24 hours after the examination to prevent inflammation. 
    2. The gauze can be removed 24 hours after examination. 
    3. The patient may feel sore in 2-3 days after examination.
    4. If there are the following situations, please notify medical and nursing personnel immediately: 
      1. The dressing gets wet.
      2. The wound is bleeding again or have any secretions.
      3. The pain is prolonged and worsen or becomes unbearable.
cb417c945b19ca6d2663f6fb4105a3e1.png
Figure 1 post-examination posture
 
 
Reference 
  1. Chan, C. M.(2019). Nursing for children with cancer. In P. F. Mu (Ed.), Pediatric Nursing (1st ed., pp. 713-719). New Wun Ching.
  2. Liu, Y. M.(2018). Children's blood disorders and nursing. In M. C. Huang & L. C. Chiang (Eds.), Pediatric Nursing (6th ed., pp. 41-42). Yeong Dah Book.
  3. Tomasian, A., & Jennings, J. W. (2021). Bone marrow aspiration and biopsy: techniques and practice implications. Skeletal Radiology, 51, 81-88. https://doi.org/10.1007/s00256-021-03882-w
  4. Zarnegar-Lumley, S., Lange, K. R., Mathias, M. D., Nakajima-Hatano, M., Offer, K. M., Ogu, U. O., Ortiz,M. V., Tan, K. S., Kellick, M., Roberts , S.S., Basu, E. M., & Dingeman, R. S. (2019). Localanesthesia with general anesthesia for pediatric bone marrow procedures. Pediatrics, 144(2).e20183829. https://doi.org/10.1542/peds.2018-3829
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    Taipei Veterans General Hospital 
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