Where is the pain of bone puncture?
Generally speaking, punctures will cause pain when the needle passes through the skin. This is one. Secondly, the nerves of the bones are mainly distributed on the periosteum. When the needle punctures the periosteum, the patient will inevitably feel pain. For the above two, when the doctor gives the patient local anesthesia before the operation, injecting the local anesthetic into the skin periosteum can solve these pain problems. 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 draws out the bone marrow. At this time, in order to relieve the patient's pain, the doctor needs to draw slowly.
How much to draw depends on the specific case. In some cases, one milliliter of blood can be drawn to obtain bone marrow, but in others, it may not be the case. For a simple bone marrow smear, you don’t need to draw more blood. If you want to do additional tests such as gene culture, you must draw more blood, and use a large syringe or even a 20 ml syringe.
The assistant stands opposite the doctor who is in charge of the puncture, helping to observe the child's condition, assisting with the preparation of bone marrow smears, etc. Bone marrow smears are made by dropping the bone marrow onto a slide after it is extracted, which is a bit like making a slide of plant leaves in middle school biology class. For example, when the child today was first diagnosed, more than five slides were required.
Dr. Tian told the students: "Bone marrow puncture has less risk than other puncture procedures, so don't be nervous."
The teacher's words can be understood in this way. To draw bone marrow, you must find a large bone in the body. Bones are large targets, unlike deep vein puncture, which requires puncturing deep, thin and slippery blood vessels, like a blind man touching an elephant. Lumbar puncture is difficult and risky. As mentioned before, if you are not careful when drawing cerebrospinal fluid, it will affect the patient's brain.
Bone marrow puncture is a procedure that can be felt through the skin. It is easy to get the needle in place with a small chance of error and a small risk of complications. In addition, bone marrow puncture provides doctors with many target options. If this bone is not palpable or cannot be drawn out, another bone can be found for drawing out.
Usually in clinical practice, bone marrow can be drawn from the sternum, ilium and tibia. The best bone to be punctured is the ilium, which has a large bone marrow cavity and is easy to draw. Children under six months old usually draw from the tibia, which is the safest puncture site.
Given the high risk of sternal puncture, for safety reasons, and with such a family member present, the doctor thought about it and did not dare to take the risk of sternal puncture, and directly chose the iliac bone that everyone likes the most. The needle insertion point for iliac bone extraction can be the anterior superior iliac spine or the posterior superior iliac spine.
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Zhang Desheng had interned in the Hematology Department of the National Association before. He had seen the teacher do bone marrow puncture and helped the teacher. Therefore, he was assigned by Teacher Tian to do the puncture. Zhao Zhaowei was his assistant.
Several surgical students who had never been to the National Association for Hematology Department were watching from the sidelines. Xie was a special student who was specifically asked by the patient's family to take care of the child and stood next to the puncture doctor to help hold the child down.
In any puncture operation, accurate positioning of the anatomical position of the puncture target is of utmost importance.
Zhang Desheng touched the child's ilium with his sterile gloved fingers and looked at Xie and asked: Am I touching the right place, Yingying?
As we all know, Xie is a top student in anatomical positioning. The smarter classmates will seize the opportunity to ask Xie for advice.
The child was lying on his back. Xie Wanying inferred that the student might want to insert the needle through the anterior superior iliac spine and said: "If you are not sure about the puncture, it is better to choose the posterior superior iliac spine. The posterior superior iliac spine is larger than the anterior superior iliac spine and is easier to puncture. If you are worried that the position of the child with the posterior superior iliac spine is difficult to fix, we will help you."
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