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Bone Marrow Biopsy Video
This is Dr. Evan Slater, an oncologist to describe the procedure.
Okay, the first thing we're going to do is use some betadine to clean off the skin, so it will be a little cold to you. I'm going to do that now. And the key thing with doing this is to make sure that the periosteum is well anesthetized because there are no pain fibers in the bone. So you need to get the periosteum good and numb and we'll do that, okay, so there will be no pain once we get started.
We try to go on the up slope of the ridge of the iliac crest and the best way to find that is to use the three finger up from the crack, where the buttocks divides and three fingers over that basically gets you to the iliac crest, okay you feel it. He is nice and thin so it makes it easy. Some 400 pounders, you can't feel anything and you just have to go by your landmarks or your measurements.
So here we go, we're going to clean things off a little bit. You've got artwork to look at while we're working here; this is special treatment we don't usually get. And we'll go ahead and put some towels here to drape the area.
First of all, we're going to go ahead and use a small syringe and needle to anesthetize the periosteum, the two types of needles we use is a shorter needle that is used for the aspirate and it's just a straight on needle with an open center to aspirate the liquid part of the marrow. And then the second part is done with a Jimshadi needle. This is a beveled needle on the end, and this is our biopsy. We impact this into the cortex and then go ahead and get a cone like or a cylinder like specimen that, because of the needle being beveled will break off and expand within the cylinder, and allow us to withdraw a core that we can look at under the microscope.
You'll feel me working a little bit back here. The first thing we're going to do is put a little bit of lidocaine in so there will be some stinging initially, under the skin. Now, a bit deeper, we'll go the top of the bone and actually embed into the periosteum so it's hard to push in the lidocaine. You want to infiltrate under the periosteum, up and down stream. A little bit bigger needle. Okay, we'll let that take effect for a few seconds there, and the people that are thin; you can just leave this protective part on there. You'll feel a little bit of pressure, but there shouldn't be any sharp pain, through the cortex and you usually feel a little bit of a pop to get into the cavity of the marrow. Oh I feel like Martha Stewart.
Okay, and now this is the only part that is going to maybe hurt a little bit, there will be like an ache in your hip for about five seconds as I pull out the liquid part of the marrow, that's the pressure being transmitted down the periosteum, but then it's done, okay. So take a deep breath, here we go, one, two, three, okay, and maybe only 30% of the people have some discomfort. It sounds like he's going pretty good, and this is the liquid part of the marrow we're sending for culture in this situation, a flow cytometry which can find evidence of lymphoma or myeloma.
The patient had no sedatives or hypnotics or pain medication. So again the point is that anesthetizing the periosteum is the key to a successful bone marrow. So go ahead and do the biopsy now, and I don't use a knife, I use the same hold, just move it a little bit so I'm in a different part of the bone, and then insert the Jamshidi needle into the cortex. And then you work the needle downward in circular motions, you're taking the core of the bone marrow. Now you need to break off the bone marrow until you get that core to withdraw into the cylinder of the needle. So kind of rock it back and forth a little bit and then do a 360 degrees turns in both directions and then slowly come back with the needle, and that's our one centimeter sample and that's adequate.
It's Miller, it's Miller time, that's it. We'll put a little complement Band-Aid and put some ice on it for about 15, 20 minutes, and then you should be back downstairs.
Thank you very much Dr. Slater.
Bone Marrow Biopsy Video procedures and processes | |
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| Education | Upload TimePublished on 1 Sep 2012 |
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