Bone Marrow Biopsy

[accent]

I am a new manager on an oncology unit, and assessing various practices being performed. One concerns bone marrow biopsies. What pain management process are you using when performing a bone marrow biopsy? For example - moderate sedation.

Thanks

[rcaud]

On our unit we pre-med with ativan and morphine, then the physician injects lidocaine and waits for 5-10 minutes. I haven't seen a bad one yet.

[blondy2061h, MSN, RN]

We generally use conscious sedation (dilaudid and versed) or actiq suckers + ativan if the patient is nervous. Some patients request nothing more than their usual pain med dose before.

[iwanna]

I know this is an older post, but wanted to add a quick reply. I had a bone marrow biopsy in drs. office. I was scared stiff. I did not receive any sedating meds, nor analgesics. I thought that I would be laid up for the rest of the day, but I was fine. In fact, I remember the dr. asking me if was working that afternoon. I thought that he was nuts to even ask. But, now I know that was just his confidence and letting me know that it was no big deal. And, he was right. I expected horrible pain. I have heard horror stories and learned to never listen to them, anymore. I guess it depends on the person's pain threshold and the dr. My dr. was fantastic. The worst part was the lidocaine sting. It was just a pressure feeling after that. I took tylenol for the pain afterwards.

[RN813]

It is amazing how differently treatments are "treated" in the different settings i.e. inpt or clinic. I work in a hospital and we don't perform many bx at bedside I think because we are unable to give conscience sedation on the floor. I'd rather my pt be comfortable rather than have someone tell them they can't have medication.

[exnihilo]

I just found allnurses.com and I am thrilled. The info coming from nurses is so reality-based. You are on the front lines and you share in detail exactly what I can use to understand what I need to.

Regarding this thread, I too am amazed at the varied pain-prevention approaches that are used. But, I now know exactly what to ask for if I or a family member undergoes either the biopsy or the aspiration.

Even if I still worry that these procedures can be incredibly painful, my anxiety is GONE now that I have the INFORMATION about how to prevent the pain.

THANK YOU NURSES SO, SO, SO MUCH FOR CARING FOR US pt's AND FOR SHARING THE INFO.

[caroladybelle, BSN, RN]

I have had several bone marrow biopsies done. And there was nothing more than ibuprofen (I am allergic to tylenol) given.

It is uncomfortable and nerve wracking, but not nearly as uncomfortable as the bronch (w/sedation, but no initial pain med). I would not put it at excruciating compared to other procedures.

Many people have a poor pain tolerance. And most people getting BMBx done are :nervous, scared, sick, fatigued...and they may be getting them done repeatedly. Making them comfortable should be paramount. Many of them will have more painful, uncomfortable, scary procedures in the near future...let us be kind to them when we can.

I agree, and I too have had bone marrow biopsies done without pain meds.

My issue is if we are going to give meds, let us be honest, ethical and responsible. If an MD orders comes in at the last minute and orders ativan and morphine/fentanyl.....this is CONCIOUS SEDATION, and the nurse doing it, should not be responsible for 6 patients. Too many timesMDS are ordering what by ANY measure is CS, yet doesn't call it that....you have a nurse coming out of report at 0730, responsible for 6 patients including diabetics that nedd insulin, pts crawling out of bed, confused and falling, and the nurse having to set up and assist for BMT, and push narcs/seds with no monitoring equipment.

That is just wrong and terribly unsafe, yet frequently is the expectation of them.

[littleredmare]

I work in outpatient hem/onc. We do biopsies at the bedside outpatient clinic. They should not hurt. If they hurt, your MD/NP/PA has not numbed up the area enough/used enough lidocaine. The most important part is to make sure that the periosteum (outer bone) is numbed well, you honestly need to numb the bone itself. There should be no pain if the practitioner does this well. If a person is having pain, someone is not doing their job right.

[SalishRN]

If a pt requests pain medication, then they SHOULD be given pain medication. I have educated pt that they have the right to refuse a procedure if they feel they will not be able to tolerate the pain/discomfort. I assure they also know some Drs will be frustrated by their choice and they run the risk of not getting a very needed procedure. However, I have never seen a bone marrow biopsy not done because a pt refused one without pain needs. The Drs will prescribe pain medication if the pt/nurse are persistent. That is the right thing to do. All pt experience pain differently. It is not ok to say most pts don't need pain meeds, so this pt doesn't either.

Also...to the previous poster I feel 6 pts on an oncology floor is too many. I would NOT work in a hospital like that. We need to DEMAND appropriate pt/nurse ratios.

[littleredmare]

In response to the previous poster,

yes if my patient asks for pain meds or anti-anxiety meds prior to the procedure, of course I will give it to them. The last thing I want is my patient (who already has enough ill stuff going on if they need a BMB) to have pain or deprive them comfort. That comes first. Also, if I sense that someone seems anxious (Nursey Spidey-sense) it is always good to offer pain/anxiety meds prior to procedure. Most of the Dr's I work with offer as most of them are pretty great.

[xtxrn, ASN, RN]

I've had 4 BMBXs in the last 1 1/2 years. It's worse having ABGs done. The doc used a decent amount of lidocaine, had me positioned well, and just got it done. :)

When I first heard I'd have to have one, I remembered watching during school, and the one I helped with back in the late 80s (used Versed IV at the bedside then). The noise bothered me the most, so I wasn't anticipating it being no big deal.

I could feel the aspiration, but it wasn't horrible. There was pressure, and I had to "hold position" fairly firmly...but other than that, it was more of a pain in the butt (no pun intended ) to have to wait for 20-30 minutes so they could check for bleeding. Not even worth ibuprofen ime.

BUT, if I hadn't had them, I'd still be thinking about how it LOOKED when the patients got them.... in school, 3 of us nearly hit the floor when the "crunch" happened. We were less than helpful for the poor patient (who did well :))