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VID1-00598-EN | B | Posterior Iliac Crest Bone Marrow Aspiration - Prone Position

David Crane

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Posterior Iliac Crest Bone Marrow Aspiration - Prone Position

All right. This is Doctor Crane. We're here at Bluetail medical Group, and today we're going to be treating a 48 year old male. When we're looking at getting bone marrow draws, the easiest place to get bone marrow in the largest aspirate site is going to be from the pelvis, from the iliacus here, the iliac bone. The landmarks that I typically recommend using are the posterior superior iliac spine, the sacral spine. And then I always look at the transverse sacral ligament and the and one of these sacral foramen. If you have somebody who's really big and really large, sometimes you'll see on the ultrasound you'll see these transverse processes of the spinous process at L5. So when you're first starting you really want to make sure that you line up these three sites cis sacral spine. And that we can see some foramen here and a transverse sacral ligament. And then when we do our aspiration, the biggest problem is that if you get your needle on this cis, you'll actually kind of skive off and get into the gluteus. And patients don't like that because it gives them a little gluteal tear. And it takes months for that to heal up. The other problem is if you go straight down into the C joint, everybody asks, you know, well, how do you know where you are? And typically what I tell people is that you're aiming for the anterior superior iliac spine. So when your needle is on this posterior superior iliac spine, you're actually aiming for aiming for the front. You're kind of aiming for this axis, and that will be your direction as you get through the bone. Once you're through the cortex of the bone and you're in the marrow, the bony cortex is going to direct your needle. It won't let it go out of the cortex. It will keep it within the cortex itself. The other thing that I tell people is when you get your landmarks with your ultrasound and you numbness up, the biggest thing to make sure that they don't have as much pain is you want to lift the periosteum from the bone, make sure you numb the periosteum if you want to make your bone marrow fairly painless. So we kind of drew the model out. We're going to look at that posterior superior iliac spine here. And then I drew out the spinous processes. So on the ultrasound underneath that orange carrot right now is the sacral spine. And then you're going to see a foramen right there. And you're going to see the posterior superior iliac crest right there. And there's a transverse sacral ligament that runs between it runs crossways. So those are our three landmarks that we're going to proof out to make sure that we're in the right spot. You can see that that posterior superior iliac spine is about a centimeter in width. That's about one centimeter, half a centimeter under the skin surface. So I'm kind of gauging on the ultrasound how deep underneath the skin surface I have to go. Obviously if you have a really large person we can go down 6 or 7cm. So sometimes it does behoove you to go to the lateral superior crust rather than stay on this, sis. But for the most part, when you're starting out, this is the easiest spot to go to. We've kind of marked our site already. I usually put in an x y coordinate only. I just put my probe on transverse and we get an x y coordinate, and we'll get ready to get some bone marrow. I'm going to kind of put my fingers right on the sides of the sis, so I can feel the inside and the outside edge. So what I'm going to do is I'm going to feel that bony cortex and I go straight into the cortex, and I'm going to be pushing pretty darn hard, because I'm going to try to lift that cortex up off of the bone edge a little bit. So I can only get in maybe 2/10 or a half a CC here. So there's a CC in the periosteum. And then what I'm going to do is I'm just going to cone around the soft tissue. I treat the periosteum and the bony sis first and then I cone around. I'm going to ask for a second syringe here. We're just going to do a little skin wheel. It's actually usually the worst part. All right. So we're going to make an 11 blade poke hole here. And we're going to grab our 12 gauge bone marrow aspirate needle. And it's already been pre heparinized. So right where I'm sitting on the crest I see three lines or three centimeters here that I have access to on my needle. I want to kind of pre gauge that when that when I start going into the bone. So I felt that that self-drilling tip is in the bone. Then I can start changing my angle whichever way I want to go. So I'm kind of looking at his pelvis thinking, well, his ASIS is right underneath my finger on the front of the pelvis about here. So I just felt that I went through the cortex of the bone. So now I only have about a centimeter and a half of my line showing, and I know I want to go at least two centimeters into the marrow space. There's one centimeter, two centimeters. So we're going to start and get just like a milliliter or two ccs. And then we'll kind of turn our needle 90 degrees and I'll go three times around. And then I'm going to pull back about a half centimeter on. And then we'll do it again. And we'll just keep kind of going around and around in a circle here. So we're going to start and get a milliliter of two CCS. And then we'll kind of turn our needle 90 degrees and I'll go three times around. And then I'm going to pull back about a half centimeter. And then we'll do it again. And we'll just keep kind of going around and around in a circle here. All right. We got our first one done.

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