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VID1-00196-EN | A | Bone Marrow Aspirate Harvesting Technique

Kristin Oliver

Human

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Surgical Technique Videos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Bone Marrow Aspirate Harvesting Technique

All right. So first when you start a bone marrow aspirate, we'll start by exposing the area that we're going to draw the bone marrow from off the posterior iliac crest. So this is the posterior iliac crest approach I use ultrasound in order to help determine the best place to pull the bone marrow. I use this curvilinear probe, which is by far the better probe to use for this purpose. I then apply the probe to the lower sacrum. This is going to be really cold one, two, three cold and to determine the best spot. So if on the ultrasound I can see the sacrum right there and I take the probe right to about L5 S1, and then I'll turn my probe 90 degrees. So I can then see the sacral spine right in the middle of the Ultrasound. And then I move over and I'm sitting right on that size. Now in this case it's a little dark. So I'm going to take a little more gel. And now you can see a little better. So I kind of scan both cranial and caudad along that iliac crest until I find the nice kind of flat portion. And that's where I mark my entry point. And I do that by just doing x, y coordinates. On the ultrasound probe. I then record that and save it to the patient's chart. Then I wipe the gel off the patient with a paper towel, usually before prepping. Okay. Then at this point I have to get gowned and gloved. So then I'll use the surgical prep. We use a chlorhexidine swab In order to prep the area. Then I'll drape the patient. And this can obviously be done ahead of time by your staff, if that's how you prefer. Okay. Now, I still have my landmarks. So I take ten ccs of a dilute lidocaine, usually at about 0.0125%. I find my landmarks. So you're going to feel me give you a little stick right about now? Okay. Count of three. One. Two. Three. Little tiny stick. There you go. Good job. You're going to feel a little bit of burn. And I make my way from the subcutaneous air, right under the skin, right down to the iliac crest. And I can feel the iliac crest where I'm going to go and where I'm going to insert my aspiration needle right there. So lots of pressure. And our patient today is very lean. So the iliac crest is right below the skin. I'm going to infiltrate that area though in about a quarter sized fashion of the periosteum. And I can feel that I'm right at the top of the iliac crest. Because if I go too far this way, I feel myself fall off the edge. So this again helps confirm my landmarks that I originally determined on ultrasound. All right. Good job. I'll then take an 11 blade scalpel. And make a very small stab incision right over that area. I'll then take my bone marrow. Trocar, take off the sleeve. I always double check everything is working before I start. I then place it into the stab incision until I feel myself seated firmly on that iliac crest, and the patient will kind of know you're there. So I know I'm seated well. Now, one of the things I want to do is kind of notice the depth that I'm at when I'm sitting right on the iliac crest. So again, I know I'm just above that first mark. So I want to insert about three centimeters. So I know when I start to withdraw where to expect my marks to be at the level of the skin. So I will take and put a little firm pressure along that area. Lots of pressure, honey. Okay. Lots of pressure. Now, as I do this, you might feel cramping down into your buttock. Okay, count of three 1000. One. Two. Three. And you can tell I'm firmly seated. And then I warn the patient when I take the stylet it out. Sometimes he will get a cramping sensation in his buttock and down his leg. Okay, so on the count of three, you're going to get a little tiny pop. Okay? One. Two three. So he's going to feel that pop as I take the stylet out. I then use one of my syringes to discard the first CC of bone marrow aspirate, since sometimes there'll be small, tiny fragments of bone and periosteum, and you're much more likely to clot if you don't remove that first CC. I then take my 30 cc syringe, draw two ccs, move the trocar 90 degrees to CCS, 90 degrees two CCS, 90 degrees two CCS. Then I'll purl my trocar back about a half a centimeter and I repeat that process until I have a total of 30 ccs. So now I know I'm at 30 CCS in my syringe. Won't go any further. I slowly remove the first 30 CCS and hand it to my assistant, who will immediately filter it. I then take my second 30 cc vac lock and I can tell that by my marks, my depth. I again place that. On my trocar. I pull back. And again two CCS, two CCS. Now I'm getting towards the edge of his periosteum. It's starting to get a little bit loose. I'm not quite there. I probably have another few CCS I can draw. But now I know I'm right about at the edge, and I don't want to fall out of that periosteum. I then remove the vacuum lock. Place the trocar back in. A little bit of pressure. While remaining in the periosteum. I'll redirect my needle just slightly again watching my depth. I'll remove the trocar. And then I'll finish getting aspirate. So the key is to continue to get fresh cells from the bone marrow. And that may sometimes require redirecting. So now I'm at 30 again I hand this off for filter. I put the trocar back in and I don't remove the remove the needle until it's confirmed by my assistant that the product has filtered correctly. So once he confirms everything is set, I remove the trocar. The rest of the way, I confirm with him the settings. I want 7% and 60 cc's. I usually will hold pressure for a few minutes on the site. Then I use a 4x4 sterile 4x4 over the stab incision and place a sterile dressing. Then I usually will have the patient lay on their back for about five minutes to add some extra pressure to decrease the likelihood of a hematoma. [00:08:43] And that's it.

Bone Marrow Aspirate Harvesting Technique

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