Using the needle threading method from the bone

6.1 Anterior superior iliac spine puncture

6.1.1 The patient is supine, and a relatively wide segment of the anterior superior iliac spine 1-1.5 cm back is taken as the puncture point. After routine local disinfection, a hole towel is laid, and the local anesthesia should reach the periosteum.

6.1.2 The operator's left thumb and forefinger pinpoint the skin on the inside and outside of the anterior superior iliac spine, respectively, and the right hand holds the puncture needle vertically to penetrate the periosteum and then advance 1cm to reach the bone marrow cavity.

6.1.3 When piercing the bone marrow cavity, there is a sense of loss, immediately pull out the needle core, connect a 20ml sterile dry syringe, and extract about 0.2ml of bone marrow for smear examination; for culture, take 3 to 5ml of bone marrow.

6.1.4 Insert the needle core back after the operation, pull out the needle, apply sterile gauze locally, and fix it with adhesive tape.

6.2 Posterior superior spine puncture

6.2.1 When the patient is lying on the side or prone, the posterior superior iliac spine generally protrudes above the buttocks, on both sides of the able bone; or the intersection of 6-8 cm below the upper edge of the skeleton and 2-4 cm lateral to the spine is taken as the puncture point .

6.2.2 The direction of the puncture needle is almost perpendicular to the back and slightly inclined to the outside.

6.3 Manubular puncture

6.3.1 The patient is placed supine on the treatment table, with a pillow on the shoulder and back to make the head lean back as much as possible and turn to the left to fully expose the suprasternal notch.

6.3.2 The operator stands on the patient's head, first uncovers the suprasternal notch with the left hand, and presses the skin down against the upper edge of the manubrium, holding the needle with the right hand from the center of the notch along the level of the manubrium. Insert the needle in the same direction, slowly rotate and pierce, and reach the midline depth of about 0.5-1.0 cm of the bone plate on the upper edge of the manubrium.

6.4 Spinous process puncture

6.4.1 The patient should lie on the side or sit on the chair in reverse, with both arms on the back of the chair, and the head rests on the arms.

6.4.2 The spinous process of the upper lumbar vertebra is used as the puncture point. The left thumb and index finger are used to fix the skin above and below the spinous process to be punctured, and the needle is held in the right to pierce vertically from the side or center of the spinous process.

6.5 Tibial puncture (only for children under 2 years old)

6.5.1 The child lies supine on the treatment table, the lower limb is fixed by the assistant, and the medial iliac bone is selected as the puncture point about 1cm below the plane of the tibial tubercle (or the junction of the upper and middle 1/3 of the iliac bone).

6.5.2 Fix the skin with the thumb and forefinger of the left hand, hold the needle in the right hand, and pierce it in a vertical direction at the middle of the bone surface.

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