Sternal puncture is a method of examining the bone marrow. This method consists in a bone marrow puncture of the anterior wall of the sternum using a special needle. Sternal puncture is performed both in hospital and outpatient settings. It does not matter where the puncture is performed, the main thing is that the rules of asepsis and antisepsis 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, Kassirsky's sternal puncture needle (a short needle that has a nut at the distal end, mandrin and detachable handle), gauze pad and band-aid.
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. The puncture is carried out two to three hours after eating. All drugs are canceled, with the exception of those necessary for life.testimony. It is also necessary to cancel preparations containing heparin. On the day of the procedure, it is forbidden to carry out other diagnostic, surgical procedures. It is advisable to empty the bladder and intestines before the procedure.
Performing a 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 drawn into a 10 ml syringe and a needle is inserted at an angle of 90º, anesthetizing. 3 minutes after the introduction of lidocaine, you can start the puncture. The anterior wall of the sternum is pierced with a Kassirsky needle at the level of the III-IV rib along the mid-clavicular line, it is also possible into the handle of the sternum. The needle must be inserted with a quick twisting motion. The needle passes through the compact substance of the frontal surface of the sternum and enters the medullary space, and a failure is felt. Signs of getting into the spongy space are the sensation of the cavity by the operator, and the patient - short-term pain. Next, you need to remove the mandrin from the sternal needle and attach a 20 ml syringe to it, with the help of which the bone content is aspirated. Creating a vacuum, aspirate no more than 0.20-0.30 ml. blood. After that, you need to pull out the syringe along with the needle. A gauze napkin is applied at the puncture site and an adhesive plaster is glued. The contents of the syringe are applied to the glass and a smear is prepared. When making a puncture for children, it must be remembered that the needle can pass through, this is due to sufficient elasticity of the sternum. Sternal puncture in patients who take long-term corticosteroids should be done with caution as they are prone to osteoporosis.
Complications. Indications for sternal puncture
The main complications are penetrating and bleeding. In the bone marrow, the formation of cellular elements of the blood, that is, 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 received the result, it is possible to accurately assess the activity of the hematopoietic process, the state and structural changes of cells. Sternal puncture is also performed in patients with suspected malignant neoplasms and metastasis.
