Sternary puncture is a method of studying the bone marrow. This method consists of a bone marrow puncture of the anterior wall of the sternum with a special needle. Sternary puncture is performed both in hospital and outpatient settings. It does not matter where the puncture is performed, the main thing is that the rules of asepsis and antiseptics are observed during it .
Equipment
For puncture, you need: 70º alcohol, 5% iodine solution, lidocaine or novocaine for pain relief, two syringes - 10 and 20 ml, a needle for sternal puncture Kassirsky (a short needle that has a distal end nut, mandril and detachable handle) Napkin of gauze and adhesive plaster.
Preparation of the patient
This procedure does not require special preparation. The patient on the eve and on the day of the puncture is on the usual diet. Puncture is performed two to three hours after a meal. All drugs are canceled, except for those that are necessary for life indications. It is also necessary to cancel preparations containing heparin. On the day of conducting it is forbidden to conduct other diagnostic, surgical procedures. It is advisable to empty the bladder and intestine before the procedure.
Carrying out a sternal puncture
The puncture site should be treated with 70 ° alcohol and 5% iodine solution. In the future, it is necessary to anesthetize. An anesthetic - lidocaine or novocaine - is injected into a 10 ml syringe and a needle is injected at an angle of 90 °, anesthetizing. After 3 minutes after the administration of lidocaine, a puncture can be started. The front wall of the sternum is punctured with a Kassirsky needle at the level of III-IV ribs along the median-clavicular line, and it is possible to insert the sternum into the handle. Needles need to be injected with rapid rotational movement. The needle passes through the compact substance of the frontal surface of the sternum and enters the medullar space, with a sensation of failure. Signs of falling into the spongy space are sensation by the operator of the cavity, and for the patients - of short-term pain. Next, remove the mandril from the sternal needle and attach a 20 ml syringe to it, using it to aspirate the bone contents. When creating a vacuum, aspirate no more than 0.20-0.30 ml. Blood. After this, it is necessary to pull out the syringe together with the needle. At the puncture site, a gauze napkin is applied and a sticking plaster is applied. The contents of the syringe are applied to the glass and a smear is prepared. Doing a puncture to children, it is necessary to remember that the needle can go right through, this is due to sufficient elasticity of the sternum. Sternary puncture for patients who take long-term corticosteroids should be carried out with caution, since they have a tendency to osteoporosis.
Complications. Indications for sternal puncture
The main complications are through puncture and bleeding. In the bone marrow there is the formation of cellular elements of blood, that is, hematopoiesis. Sternary puncture is necessary to confirm the diagnosis of many diseases: anemia, leukopenia or leukocytosis, thrombocytosis or thrombopenia, as well as functional bone marrow failure. Having obtained the result, it is possible to accurately assess the activity of the hematopoiesis process, the state and structural changes in the cells. Sternary puncture is also performed by patients with suspected malignant neoplasms and metastasis.