Generally speaking, puncture will cause pain when the needle penetrates the skin. This is first. Secondly, the nerves of the bones are mainly distributed on the periosteum. When the needle punctures the periosteum, the patient will definitely feel pain. The above two, before the operation
When doctors give local anesthesia to patients, they can solve these pain problems by injecting the local anesthetic into the skin and periosteum. The third pain is the pain that cannot be solved. It is the pain caused by the negative pressure when the needle enters the bone marrow cavity and extracts the bone marrow.
.At this moment, in order to relieve the patient's pain, the doctor needs to pump more slowly.
How much to draw depends on the specific case. In some cases, one milliliter can be drawn to extract the bone marrow, but in some cases, it may not be possible. For a simple bone marrow smear, you don’t need to draw more. If you want to do additional tests such as cultured genes, you must draw more points, and use a large size.
Syringes Even 20 ml syringes are used.
The assistant stands opposite the doctor who is responsible for the puncture, helping to observe the patient's condition, lay hands, and help prepare bone marrow smears. Bone marrow smears are taken out of the bone marrow and dropped on a glass slide. It is somewhat similar to making plant leaf slides in middle school biology class. Like today.
The initial diagnosis of this child requires more than five slides.
Dr. Tian told the students: "Compared with other punctures, bone puncture has less risk, so there is no need to be nervous."
The teacher’s words can be understood this way. To extract bone marrow, you must look for big bones in the body. Bone targets are large, unlike deep venipuncture, which requires piercing deep, thin and slippery blood vessels, like a blind man touching an elephant. Lumbar puncture is more difficult.
The risks are high. As mentioned before, careless removal of cerebrospinal fluid can affect the patient's brain.
For bone puncture, if you feel the bone that can be felt through the skin, it is easy to place a needle with one needle, the probability of error is small, and the risk of complications is also small. Moreover, bone puncture has many targets for the doctor to choose from. This bone cannot be touched or
If you can't pull it out, you can find another bone to pull out.
Usually in clinical practice, bone puncture can be used to extract the sternum, ilium and tibia. The best way to penetrate is the iliac bone. There is a lot of bone marrow in the large medullary cavity of the ilium and it is easy to extract. Children under six months old often have tibia, so the puncture position of the tibia is relatively difficult.
Said to be the safest.
In view of the high risk of sternocentesis, for safety reasons, and if there are such family members, the doctor did not dare to take the risk of the sternum, and directly chose the iliac bone, which is everyone's favorite. The anterior superior iliac spine can be selected as the needle insertion point for iliac bone extraction.
or posterior superior iliac spine.
Zhang Desheng had been an intern in the Department of Hematology of the National Association of Chinese Medicine before. He had seen and assisted the teacher in performing bone punctures, so he was assigned by Teacher Tian to do the punctures. Zhao Zhaowei served as an assistant.
Several surgical students who had never been to the Hematology Department of the Chinese Association were watching from the sidelines. The special one was Xie, who was named by the family of the child to take care of the child. He stood next to the puncture doctor and helped hold the child down.
For any puncture operation, it is most important to accurately locate the anatomical location of the puncture target.
Zhang Desheng touched the child's ilium with his sterile-gloved fingers, and asked classmate Xie with his eyes: Is the position I touched correct, Yingying?
As we all know, Xie is a super academic in the field of anatomy and positioning. The smarter classmates will seize the opportunity to ask Xie for advice.
The child's position was supine. Based on this, Xie Wanying inferred that the classmate might want to insert the needle from the anterior superior iliac spine. She said: If you are not too sure about the puncture, it is better to choose the posterior superior iliac spine. Compared with the anterior superior iliac spine, the posterior superior iliac spine is better.
The large plane makes it easier to puncture. If you are worried that it is difficult to fix the position of the child with the posterior superior iliac spine, we will help.