I. Definition:
This protocol covers the task of bone marrow aspiration by an Allied Health
Professional. The purpo of this standardized procedure is to allow the Allied
Health Professional to safely do a bone marrow aspiration when needed.
II. Background Information
A. Setting: Select check-off boxes (double click on gray box to lect): If Pediatrics
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are lected make sure Child Life is involved and u age appropriate language
and age appropriate developmental needs with care of children
Adults
Pediatrics
Both Adults & Pediatrics
Inpatient clinical tting
Outpatient clinical tting
Both Inpatient & Outpatient clinical tting
B.Supervision: The necessity of this protocol will be determined by the Allied
Health Professional in collaboration with the supervising physician or his/her
designee. Designee is defined as another attending physician who works directly with the supervising physician and is authorized to supervi the Allied Health
Professional.
Direct supervision will not be necessary once competency is determined, as
provided for in the protocol. The Allied Health Professional will notify the
physician immediately upon being involved in any emergency or resuscitative
events or under the following circumstances:
1. Patient decompensation or intolerance to the procedure
2. Bleeding that is not resolved
3. Outcome of the procedure other than expected
C.Indications:
Need for diagnostic biopsy
D.Precautions:
Note evidence of significant thrombocytopenia
III. Materials required:
1.Lidocaine cream with occlusive dressing
2.16-gauge 2-1/2 or V bone marrow needle
3.(3) 10ml syringes
4.25-gauge needles
asts5.20-gauge needles
6. 4 x 4 and 2 x 2 gauze pads
7.Povidone-iodine swabs分歧是什么意思
8.Sterile drapes
9.Lidocaine 1% multido vial
10.Alcohol swabs
11.Elastoplast adhesive, or other pressure dressing
12.Sterile gloves
IV. Procedure:
1. Prior to the procedure
•Obtain connt for procedure.
•Notify hematology to schedule BM tech.
•Determine and obtain appropriate type and do of dation and pain medications. Schedule child for anesthesia if elective and child/adolescent
visitahave no contraindications for anesthesia. Instruct patient/family in NPO
requirements.
•Prepare the patient for the procedure:
a.Explain the basic steps of the procedure, appropriate for the patient's
age, development status, and prior experience.
b.Encourage the parent's/patient’s participation, answering all questions
honestly given the available knowledge.
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c.Explain that while parts of the procedure are painful, the u of a local
anesthetic and dation medications will minimize the discomfort and
anxiety the child will experience.
d.Elicit the patient's help by encouraging them to hold as still as possible
once positioned. Reinforce the patient's help in holding still will enable
you to complete the procedure in the minimum amount of time.
e.During the procedure, explain each step in a simple manner, preparing
the patient for painful parts of the BMA.
2.Apply Lidocaine cream 1-2 hours prior to the procedure: either the staff RN
or the NP should apply the cream on the right or left iliac crest, covering an
area of approximately 3-4 cm in diameter. A transparent occlusive dressing is
then applied.
3.At the time of the procedure:
•Wash hands.
•Asmble supplies and medications, checking expiration date on BMA tray.
•Complete a time out with all elements of the preprocedure process.
•Administer dation medications, monitoring vital signs, pul oximetry, level of dation.
•Remove outer wrapping from bone marrow tray using clean technique.
•Position patient in prone or side-lying position.
•Expo area for aspiration and locate posterior superior iliac crest.
Remove Lidocaine from aspirate site. A towel roll or small pillow placed
under the hips may allow easier location of the iliac crest.
•If necessary, a member of the nursing staff will help cure the patient’s position.
•Position the parent near the child's head in order to more easily comfort the child during the procedure.
•Expo contents of bone marrow tray using aptic technique.
•Put on sterile gloves.
•Swab bone marrow site with povidone-iodine swab stick, applying some friction and working in a circular motion beginning in the center and
moving outward. Repeat x 2 with new swabs.
•Allow povidone-iodine to dry.
•Remove povidone-iodine with alcohol swab using concentric motion beginning in the center. Repeat with new swab x 2 (optional).
•Allow area to dry.
•Apply sterile drape.
•Draw up 2-3ml lidocaine 1% from a vial held by an assistant into a 3 ml syringe with a 22 gauge 1 " needle.
•Location exact point for aspiration and outline area between thumb and index finger.
•Perpendicularly inject lidocaine subcutaneously and into periosteum.
Avoid injecting too much and obscuring landmarks.
4. While allowing 2-3 minutes for lidocaine to take effect:
学习英语少儿英语启蒙•Prepare bone marrow needle, assuring stylet moves freely.
•Prepare (2) 10ml syringes, assuring plungers move freely. Remove top from one syringe and t aside. Prepare cond syringe (if needed for
special studies) using 0.2ml heparin and rinsing inside of syringe. Set
aside.
•Stretch skin taunt over puncture site, keeping crest between thumb and index finger of one hand.
•Holding bone marrow needle with stylet in place, puncture skin and advance through subcutaneous tissue, periosteum and into marrow cavity
using a steady, controlled pressure with a twisting motion. When the
needle is firmly in place and a slight give in pressure is felt, the cavity has been entered.
•Remove the stylet and quickly attach the plain syringe to the needle hub.
•Apply strong, quick suction and obtain approximately 0.5ml marrow.
•Hand syringe to the lab technician.
•Obtain other samples with heparinized syringe as needed.
•Remove needle with syringe attached with slight twisting motion.
•Maintain pressure over site approximately 2 minutes until bleeding has stopped.
•Meanwhile, remove sterile drape and clean povidone-iodine from skin with alcohol swab to avoid burn.
•Apply dry 2x2 gauze folded into quarters and cured with tightly
stretched Elastoplast.
•Prai the patient's cooperation.
bility•Inform patients / parents and child of marrow result when obtained.
5. Patient conditions requiring consultation:
•Unusual bleeding, pain or signs/symptoms of concern to the practitioner will be brought to the attention of the responsible fellow or attending
physician.
•After two unsuccessful attempts by the NP, a fellow, attending or another NP will complete the procedure.
6. Patient education:
•The parents and/or patient are instructed to remove the dressing after 24 hours, obrving for signs
of infection, unusual bleeding, or any other
drainage on the dressing. If either is noted, the practitioner should be
informed. The site should be checked daily thereafter until healed for signs
of infection.
•It is not unusual to feel an aching or bruid feeling for veral days after the procedure. This may be relieved with a warm pack. The nur
practitioner should be notified if pain persists beyond veral days or
worning pain..
V. Documentation
A. Inpatient documentation is in the UCARE procedure note and outpatient will be in
the event note.
1. Documentation of the pretreatment evaluation
2. Record the time out, procedure, the outcome, patient tolerance, medications
given, and the plan in the progress note
B. All abnormal or unexpected findings are reviewed with the supervising
physician.
VI. Competency Asssment疯狂英语杂志官网
A.Initial Competence
1. The Allied Health Professional will be instructed on the efficacy and the
indications of this therapy and demonstrate understanding of such.
2. The Allied Health Professional will demonstrate knowledge of the following:
a. Medical indication and contraindications of bone marrow aspiration
b. Risks and benefits of the procedure
c. Related anatomy and physiology
d. Connt process (if applicable)
e. Steps in performing the procedure
f. Documentation of the procedure
g. Ability to interpret results and implications in management.
3. Allied Health Professional will obrve the supervising physician perform each
procedure three times in its entirety.
4. Allied Health Professional will perform the procedure five times under direct
supervision of attending physician.
5. Supervising physician will document Allied Health Professional’s competency
prior to performing procedure without direct supervision.
6. The Allied Health Professional ‘s Attending Physician will ensure the
completion of the clinical competency sign off documents and provide them
for filing in their skills asssment, as well as a copy to be nt to the Medical
Staff Office
B. Continued Proficiency
1.The Allied Health Professional will demonstrate competence by successful
completion of the initial orientation.
2.Each candidate will be initially proctored and signed off by an attending
physician. Allied Health Professional must perform this procedure at leastfrequent
five times per year. In cas where this minimum is not met, the attending,
定语must again sign off the procedure for the Allied Health Professional. The
Allied Health Professional will be signed off by the proctor after
demonstrating 100% accuracy in completing the procedure.
3.Demonstration of continued competence shall be monitored through the
annual evaluation and documentation of successfully performing of successful
performing three procedures within the past year.
