Sternal puncture is a method for examining bone marrow. This method consists in bone marrow puncture of the anterior wall of the sternum with a special needle. Sternal puncture is performed both in a hospital and in an outpatient setting. It does not matter where the puncture is carried out, the main thing is that the rules of asepsis and antiseptic are observed during it .
Equipment
For puncture, you need: 70º alcohol, 5% iodine solution, lidocaine or novocaine for pain relief, two syringes - 10 and 20 ml, a needle for Kassirsky's sternal puncture (a short needle that has a nut, mandrin and a removable handle on the distal end), gauze napkin and adhesive plaster.
Patient preparation
This procedure does not require special preparation. The patient on the eve and on the day of the puncture is on a normal diet. Puncture is carried out two to three hours after eating. All drugs are canceled, with the exception of those that are necessary for health reasons. It is also necessary to cancel drugs containing heparin. On the day of carrying out it is forbidden to carry out other diagnostic, surgical procedures. It is advisable to empty the bladder and intestines before the procedure.
Sternal puncture
The puncture site must be treated with 70º alcohol and 5% iodine solution. In the future, it is necessary to anesthetize. An anesthetic, lidocaine or novocaine, is collected in a 10 ml syringe and a needle is inserted at an angle of 90 °, anesthetizing. 3 minutes after the introduction of lidocaine, puncture can begin. The front wall of the sternum is pierced with a Kassirsky needle at the level of the III-IV ribs along the mid-clavicular line, and it can also be used in the
sternum handle. The needle must be inserted with a quick
rotational movement. The needle passes through the compact substance of the frontal surface of the sternum and enters the bone marrow space, while there is a failure. Signs of getting into the spongy space are the sensation by the operator of the cavity, and the patient - a short-term pain. Next, it is necessary to remove the mandrin from the sternal needle and attach a 20 ml syringe to it, with the help of which the bone contents are aspirated. Creating a vacuum, aspirate no more than 0.20-0.30 ml. blood. After this, remove the syringe with the needle. A gauze napkin is applied at the puncture site and a band-aid is glued. The contents of the syringe are applied to the glass and a smear is prepared. When doing a puncture for children, it is necessary to remember that the needle can pass through, this is due to the sufficient elasticity of the sternum. Sternal puncture for patients who take corticosteroids for a long time should be carried out with caution, as they are prone to osteoporosis.
Complications Indications for sternal puncture
The main complications are through piercing and bleeding. In the bone marrow, the formation of cellular elements of the blood, i.e. hematopoiesis, occurs. Sternal puncture is necessary to confirm the diagnosis of many diseases: anemia, leukopenia or leukocytosis, thrombocytosis or thrombopenia, as well as functional bone marrow failure. Having obtained the result, it is possible to accurately evaluate the activity of the hematopoiesis process, the state and structural changes of cells. Sternal puncture is also performed for patients with suspected malignant neoplasms and metastasis.