Are these procedures so bad?

blondy2061h, MSN, RN · Jul 25, 2008

We nearly always do conscious sedation for bone marrow bx's. I imagine without it it would be quite painful. The nurse generally monitors vitals, makes sure the tele is set up for conscious sedation, positions the patient, and gives the conscious sedation meds. At my hospital you need to be privileged for conscious sedation.

Some patients request not to have the conscious sedation. I've never seen one of those. Most of my patients are pros at bone marrow bx and LP's.

The LP's I've seen the patient doesn't seem terribly upset over it. We don't do conscious sedation for these.

Roy Fokker, BSN, RN · Jul 25, 2008

unless you go into that field, you won't have to deal with this. I think I saw one in nursing school and that was 14 yrs ago.

I've assisted with plenty of bone marrow biopsies when I worked med-surg.

We nearly always do conscious sedation for bone marrow bx's. I imagine without it it would be quite painful. The nurse generally monitors vitals, makes sure the tele is set up for conscious sedation, positions the patient, and gives the conscious sedation meds. At my hospital you need to be privileged for conscious sedation.
The LP's I've seen the patient doesn't seem terribly upset over it. We don't do conscious sedation for these.

Great post. I cannot stress this enough - please, please, please advocate for your patient.

Conscious sedation is wonderful - besides, some hemo/onco docs have 'rough' techniques (meaning they don't bother even trying to be gentle/precise). I know some amount of pain/discomfort is inevitable but dang! Good technique can at least less the discomfort. There were a couple docs whom I wouldn't let 'em touch me... much less shove a needle into my marrow!

cheers,

prmenrs, RN · Jul 25, 2008

"...TW- the nurse's role in correctly positioning and holding a patient for an LP is of greater importance than the actual tap. If your position is wrong, you will have a traumatic tap or worse yet, no successful tap at all."

That is the absolute truth!! Esp w/babies and children! Mostly, it can be an exercise in patience, esp., w/med students and residents. (I used to ask them what they wanted to be when they grew up whenever I had to hold. )