Leclab 2.9.

12 Assisting in bone marrow transplant Bone marrow aspiration is the removal of a small amount of bone marrow fluid and cells through a large bore needle into a bone Purpose is to diagnose the disease of the blood and blood forming Goals -to detect blood disorders(e.g. leukemia or anemia) or problem that affect the bone marrow -assist in staging cancer -determine effectivity of cancer treatment -culture and sensitivity with presence of an infection -for stem cell transplant -chromosomal analysis Hematopoietic System Bone Marrow -amt of red marrow varies with age of patient childhood:red marrow is 100% of BM and present in virtually every bone adults red marrow is 50% of BM and present in sternum, ribs and pelvis and skull -70 yrs red marrow reduced to30% of BM 2 types of bone marrow -red marrow(also known as myeloid tissue -yellow marrow some white blood cells develop color is due to much higher number of fat cells 3 types of blood cells Bone marrow produces WBCs, RBCs and platelets. Caution!!! Potential complications -bleeding -infection -organ puncture Assessment -doctors order -consent -purpose

-premedication -labs: prothrombin time(PT) CBC, platelet -Medications taken: anticoagulents -Patients: knowledge and anxiety level ability to assume and maintain position allergies to antiseptic and anesthetic solutions Planning Patient position Less pain NO BLEEDING! Sufficient amount (1-2 ml or 0.5-2ml) Patient instructed what to expect -wash hands -prepare eqpt Before Explain procedure -pain with injection of anesthesia -crunching sound as needle is inserted -some pain when marrow is inserted -some pain when marrow is aspirated -takes about 15-30min -when and where procedure is done During -monitor VS -describe steps as needed -maintain aseptic tech -observe for signs of bleeding and pain(pallor, diaphoresis and faintness) -assist in prep/collection of specimen -apply pressure dressing after needle is withdrawn(5-10 min or according to hospital policy) After -VS q 15 min for 2 hrs -monitor client for pain, bleeding hematoma -report for unusualities -assist patient to a comfortable position -provide analgesic as ordered -label and send specimen to lab(underline in red pen) Teaching considerations Before: encourage verbalization of concerns and anxiety about the procedure

During: emphasize importance of remaining still After: encourage to follow up test results, instruct to contact AP if tenderness and redness appear at puncture site Documentation -the procedure -physician -vital signs -pre meds and type of anesthesia -puncture site: location..