I want to know the role of the nurse in bone marrow aspiration

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Hi, I am a student nurse from the island of Trinidad and I was wondering if I could get some assistance on something. Okay so I was given an assignment to write on the role of the nurse in bone marrow aspiration....now I was thinking since this procedure is more of an outpatient procedure I came up with probably teaching the patient about the procedure and why it should be done or in the case of a warded patient providing comfort or pain relief. I know this is probably not all their is to the nurse's role....so could someone please help my out it would be really appreciated.....Thanx in advance

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Specializes in med/surg, telemetry, IV therapy, mgmt.

a bone marrow aspiration is when the physician obtains soft tissue from the medullary canal of long bone (femur, tibia, and humerus) and interstices of cancellous bone (sternum, rib, pelvis) for histologic and hematologic examination of hamatopoiesis. the bone marrow is a suspension of blood, fat, and developing blood cells which can be examined for all stages of cell maturation as well as the iron stored. it can be done by aspiration or needle biopsy using local anesthetic. with an aspiration biopsy fluid is removed from bone marrow. in a needle biopsy a core of bone marrow cells is removed. both types of specimens may be obtained during the same session. the purpose of the biopsy is to diagnose thrombocytopenia, leukemias, myelomas, granuloma, megaloblastic anemias, cancer, fibromas, the cause of infection, to stage diseases (i.e. hodgkin's) and lymphomas, to evaluate the effect of chemotherapy, to monitor myelosuppression, to determine if marrow is the cause of reduced blood cells in the peripheral bloodstream and to document deficient iron stores.

nurses role: make sure the patient has signed the consent form. check with the patient for any allergies to medications. obtain a history of the patient's blood and immune systems and collect any previous cbcs, ptts, pts, platelet counts or other labwork pertaining to the blood or immune systems that has been done. blood collections to assess coagulation ability may be ordered before the test so the nurse will need to make sure they are done before the test. obtain a list of the patient's medications and note any that may affect coagulation (they should be discontinued 14 days before this procedure). a sedative may be ordered prior to testing and it will be the responsibility of the nurse to administer it. confirm the patient's identity before the test starts. help position the patient and instruct them to remain as still as possible. for a bone marrow aspiration, the site is prepped and draped and a local anesthetic is injected (by the doctor) and the procedure performed. the site may require suturing after the procedure. the nurse may be required to make sure any specimens collected are properly labeled and sent to the lab. pressure is applied to the biopsy site and it needs to be observed for bleeding. watch for symptoms of infection and report any erythema or tenderness to the doctor. monitor for signs and symptoms of shock (increased pulse and decreased blood pressure). keep the patient on bed rest for 30 to 60 minutes after the test. the doctor may order the patient to be npo for several hours after the test to avoid nausea and vomiting. the site will be painful for several days and the patient may require analgesics. be aware that the complications to watch for from this procedure are hemorrhage, infection, symptoms of accidental puncture of the mediastinum and fracture and inadvertent puncture of the heart or any of the great vessels if the test was done on the sternum.

teaching connected with this test: you would always explain to the patient why the test is being done, that a blood sample (coagulation studies) will need to be drawn before the actual bone marrow aspiration, why sedation may be ordered (promote relaxation) approximately how long the test will take (5 to 10 minutes), and what site the doctor will use (sternum, anterior or posterior iliac crest, cerebral spinous process, rib or tibia) if you know. tell the patient that he will feel pressure when the needle is inserted and a sensation of pulling as the marrow is removed. pressure will be applied after the needle is withdrawn until the bleeding stops. let the patient know that sutures may be needed to close the site if a biopsy rather than an aspiration is performed. instruct the patient that after the test he needs to report any bleeding that completely soaks the dressing or that continues for more than 24 hours--reinforce it, but do not remove it and to take pain medication as needed and ordered over the next few days. the patient should report any tenderness and erythema (signs of infection) to the physician.

  • (pages 81-82, nurse's 5-minute clinical consult: diagnostic tests from lippincott williams & wilkins)
  • (pages 160-165, mosby's diagnostic and laboratory test reference, 4th edition, by kathleen deska pagana and timothy james pagana)
  • (pages 206-211, davis's comprehensive handbook of laboratory and diagnostic tests with nursing implications, 2nd edition, by anne m. van leeuwen, todd r. kranpitz and lynette smith)

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Thank you so much this is more information than I thought I would have gotten.This really helped, thanks again.:up:

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Specializes in med/surg, telemetry, IV therapy, mgmt.

You are very welcome. Best wishes to you.

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I have one more question for you daytonite if you don't mind:). Will the role of the nurse be the same for any other aspiration procedure?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Each procedure will have different things that may need to be specifically for it, but for the most part many of the things the nurse does are the same.

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