Is a procedure performed by the doctor where a

special needle is inserted into the bone marrow to

obtain bone marrow tissue specimen.
 Erythrocytes
 Leukocytes
 Thrombocytes
 To diagnosis/ staging of diseases
 Leukemia
 Multiple myeloma
 Lymphoma
 Anemia
 Thrombocytopenia
 Pancytopenia

 To monitor the development of hemolytic

disease and respond towards the treatment given.

 To obtain more information on hematopoiesis.

 Haematological disorder
 Fever Unknown Origin (FUO)
 Lymphadenopathy
 Hepatosplenomegaly
 Metastatic tumour
 Tuberculosis
 Iliac Crest ( posterial and superior part, client
lie on lateral or prone position)
 Sternum (2nd space of sternum)
 Tibia Crest ( babies below 1 year)
 Infection
 Bleeding
 Bleeding disorders
 Infection of the skin overlying the area from
which the biopsy is to be taken
 Infection in the bloodstream
 Severe osteoporosis
 Check doctor’s order in progress note:
 Right client
 Selected site for procedure
 Any pre-medication order
Check for consent form is sign by doctor and client.
 Assess client’s:
Lever of consciousness or restless
Ability to assume position required for
procedure.
  Skin of procedure site
 Vital sign

Notify for lab Technician on call

 Prepare environment
 Second nurse as assistant
 Lab technician with glass slide
 Carbolised tray
 Big tray with:
• Disposable dressing set
• Extra cotton balls and gauzes
• 1 pair of sterile gloves
• Face mask
• 1 Fenestrated towel
• Bone marrow aspiration needle with inner stylet
•Cleansing solution (surgiacal spirit 70% and
Povidone.
 • Lignocaine 1% or 2%
• Syringes: 3ml×2, 5ml×2 and 20ml×2
• Needles: 18G×2 and 23G×2
• Heparin saline 5ml×2
• Elastoplast
• Medication tray with prepared pre-medication
drugs.

Laboratory form according to type of test.

Wash hand.
Greet client and check ID tag.
Explain procedure.
Provide privacy.
Adjust bed.
Second nurse position client according to
doctor’s chosen site for procedure.
Expose insertion site and place incopad
underneath.
1st nurse assist the doctor throughout procedure:
• open dressing set follow by all sterile items as
per requirement needs.
• Pour solution
• Give assistant to doctor when necessary

2nd nurse observe client’s condition for difficulty

in breathing or unbearable pain throughout the
procedure.

 Maintain client in supine position and check

client’s vital sign hourly for 4 hours.
Make client comfort.
 Put up both cot side and place call bell within
the client’s reach.
Cleat trolley and wash hands.
 Document in nursing care plan.
 Physical preparation
• Make sure the doctor have obtain consent
from client
• Provide clear explanation
• Make sure the puncture site has been cleaned
• check vital sign.
 Prepare equipments
•Prepare trolley aseptically
•Make sure equipments are complete

Make sure laboratory technicians has been

inform more earlier.( Technician must be present
during procedure because aspirated bone marrow
is smeared immediately on a glass slide.)
 Help client to remain in the right position
 Assist the doctor in the procedure. ( Prepare
the equipments and hold the client)
 Monitor vital signs during procedure to dectect
complication.
 Place the client in supine position and apply
sandbag at the puncture site at least for 6 hours
to prevent bleeding complication.
 Observe the pressure dressing is tight, clean
and no signs of bleeding to prevent infection.
 Observe the client until their condition stable
and recover.
Monitor vital signs after the procedure.
 Tidy the equipment and make sure CSSD
instruments are complete before sending to
autoclave.