II. Step 1: Choose site for aspiration
- Posterior superior iliac spine (preferred)
- Anterior iliac crest
- Sternum at second intercostal space (higher risk)
- Anterior medial tibia (children under age 6 years)
III. Step 2: Needle Insertion
- Prepare site with antiseptic (Betadine)
- Infiltrate skin and periosteum with Lidocaine 1%
- Puncture skin at insertion site with #11 blade
- Lock cap of Jamshidi Biopsy Needle
- Insert Jamshidi Biopsy Needle onto periosteum
- Apply pressure against cap while rotating
- Direct needle through bone cortex into marrow (1 cm)
- Do not insert needle beyond Sensation of giving way
- Remove cap and obturator
IV. Step 3: Sample acquisition
- Aspirate 2 cc of marrow into 10 cc syringe
- Aspiration will cause brief sharp pain
- May insert needle 1-2 mm if unsuccessful
- Change biopsy site after 2 attempts
- Aspirate applied between two glass slides
- Biopsy core may also be obtained by similar method
V. Step 5: Completing procedure
- Remove needle
- Pressure dressing applied to biopsy site
- Patient supine for 1 hour after procedure
- Remove pressure dressing after 12 hours
VI. Complications
- Bowel injury or retroperitoneal Hemorrhage
- Local infection or Hemorrhage at biopsy site
- Dry tap
VII. References
- Lee (1999) Wintrobe's Hematology, Lippincott, p. 23-25
- O'Brien in Pfenninger (1994) Procedures, p. 1115