EQUIPMENT
Bone marrow aspiration tray:

Antiseptic solution
Sterile drape
Gauze sponges
Sterile syringes, various sizes
Needles, 23–25 gauge
Bone marrow needle

Gloves, sterile (physician)
Gloves, nonsterile (nurse)
Local anesthetic
Test tubes or glass slides
Gauze
Tape
Antiseptic ointment
Mask and goggles (physician and nurse per agency policy)

GENERAL GUIDELINES FOR DIAGNOSTIC
TESTS

1. Explain procedure to child and family. Enhances cooper-

ation and participation and reduces anxiety and fear.

2. Obtain signed consent.
3. Gather equipment. Promotes organization and effi-

ciency.

4. If possible, have child void before procedure. Promotes

comfort and avoids interruption of procedure.

5. Wash hands. Reduces transmission of microorganisms.

PROCEDURE

1. Steps 1–5 of General Guidelines.
2. Premedicate per physician’s order. Reduces discomfort

during the procedure.

3. Wash hands. Reduces transmission of microorganisms.
4. Set up tray, open supplies for physician.
5. Position child according to site of aspiration. (Site deter-

mined by physician.) (Figure 14)
a. Anterior iliac crest lateral recumbent or supine.
b. Posterior iliac crest prone or lateral recumbent with

head flexed and knees drawn up to abdomen.

c. Distal third of thigh supine with sandbag underneath.
d. Sternum supine with small pillow beneath shoulders.

Arms at sides, feet together. Elevates chest and low-
ers head.

e. Tibia supine with sandbag under proximal third of

lower leg.

f. Vertebral process prone with feet together and arms

at side.

6. Restrain child as necessary.
7. Physician will cleanse site, drape, infiltrate area with

local anesthetic and obtain specimen using sterile tech-
nique.

8. Hold pressure on puncture site for 5–15 minutes.

Prevents bleeding and hematoma formation, especially if
child thrombocytopenic.

40

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 14

SKILL 14

Assisting with Child during Bone Marrow
Aspiration and Biopsy

FIGURE 14 Common sites used for bone marrow aspiration.

continued

9. Cover puncture site with sterile pressure dressing.

Protects site.

10. Help child to comfortable position.
11. Put on nonsterile gloves.
12. Label specimens and place in appropriate bag or con-

tainer along with laboratory requisition slips. Ensures
specimen properly identified and appropriate test per-
formed.

13. Dispose of equipment in appropriate container.

Consistent with body fluid precautions.

14. Remove gloves. Wash hands. Reduces transmission of

microorganisms.

15. Send specimen to lab.
16. Monitor child for complications according to agency

policy. Check for hemorrhage and infection.
a. Vital signs may be checked as often as every 15 min-

utes for 2 hours.

b. Observe puncture site for drainage, edema, and pain.

DOCUMENTATION

1. Bone marrow aspiration performed, site, time, physi-

cian’s name.

2. How procedure tolerated.
3. Specimens obtained and sent.
4. Vital signs, pain, bleeding, drainage.
5. Type of dressing over puncture site.

41

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 14

SKILL 14

Assisting with Child during Bone Marrow
Aspiration and Biopsy

continued