II. Step 1: Choose site for aspiration

  1. Posterior superior iliac spine (preferred)
  2. Anterior iliac crest
  3. Sternum at second intercostal space (higher risk)
  4. Anterior medial tibia (children under age 6 years)

III. Step 2: Needle Insertion

  1. Prepare site with antiseptic (betadine)
  2. Infiltrate skin and periosteum with Lidocaine 1%
  3. Puncture skin at insertion site with #11 blade
  4. Lock cap of Jamshidi Biopsy Needle
  5. Insert Jamshidi Biopsy Needle onto periosteum
  6. Apply pressure against cap while rotating
  7. Direct needle through bone cortex into marrow (1 cm)
  8. Do not insert needle beyond sensation of giving way
  9. Remove cap and obturator

IV. Step 3: Sample acquisition

  1. Aspirate 2 cc of marrow into 10 cc syringe
    1. Aspiration will cause brief sharp pain
    2. May insert needle 1-2 mm if unsuccessful
    3. Change biopsy site after 2 attempts
    4. Aspirate applied between two glass slides
  2. Biopsy core may also be obtained by similar method

V. Step 5: Completing procedure

  1. Remove needle
  2. Pressure dressing applied to biopsy site
  3. Patient supine for 1 hour after procedure
  4. Remove pressure dressing after 12 hours

VI. Complications

  1. Bowel injury or retroperitoneal Hemorrhage
  2. Local infection or Hemorrhage at biopsy site
  3. Dry tap

VII. References

  1. Lee (1999) Wintrobe's Hematology, Lippincott, p. 23-25
  2. O'Brien in Pfenninger (1994) Procedures, p. 1115

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