Biomedical Engineering Reference
In-Depth Information
FIGURE 13.9
Insertion of a bone marrow needle into the proximal
humerus for bone marrow aspiration. Some drapes have been
removed for better visualization of landmarks.
FIGURE 13.8
Venepuncture of the cephalic vein.
palpated, the position of the femoral vein is identified since
it lies just medial to the artery. Rolling and movement of
a vein can be lessened by pushing down and stretching the
vessel with the nondominant hand. When possible, a tour-
niquet may be positioned so as to distend the vein. The line
of the needle should parallel the direction of the vessel with
the needle puncturing it at a shallow angle of about 15
degrees. The needle is inserted bevel side up until, upon
entrance into the vessel, a slight pop or release of pressure
is felt. At this point blood is drawn into a syringe. Alter-
natively, vacuum blood collection tubes may be used on
larger animals and especially macaques. Upon completion,
the tourniquet is released and pressure is placed on the vein
until normal hemostasis is obtained.
FIGURE 13.10
Insertion of a bone marrow needle into the iliac crest
for bone marrow aspiration. Drapes have been removed for better
visualization of landmarks.
Bone Marrow
Three common sites used for bone marrow aspiration and
biopsy in nonhuman primates are the greater trochanter of
the femur, the greater tuberosity of the humerus
(
Figure 13.9
)
Cohen, 1953
), and the iliac crest
(
Figure 13.10
). Once the nonhuman primate has been
properly anesthetized and a plan for postoperative anal-
gesia has been determined, the procedure may begin. The
area over the site is clipped and scrubbed as for aseptic
surgery. Sterile gloves and drapes should be used. Lido-
caine is used as a local block by infiltrating the surrounding
5-cm area. The periosteum should also be infiltrated with
lidocaine. This is a good time to gently probe for land-
marks. Once the lidocaine has had enough time to take
effect a small stab incision is made in the skin above the
site. The iliac crest is easily palpated and often visualized in
smaller nonhuman primates. Usually a nick is made in the
skin using a scalpel before an 18-gauge 1-inch bone
marrow needle is pushed with firm pressure and a twisting
motion into the marrow cavity. At this point, the needle
should be very firmly secured within the bone. If a biopsy is
to be performed, it should be at this point (see description
of bone biopsy below). After the biopsy, the needle is
reinserted in a slightly different location from the biopsy.
The stylet is then removed from the needle, a 10-ml syringe
attached, and the plunger pulled all the way back. The first
milliter or two of aspirate generally contains the best
quality sample. Therefore it is best to stop at 2 ml and not
allow the sample to be contaminated with excessive
amounts of blood.
A more recent publication has described a new method
for obtaining bone marrow that is less contaminated with
peripheral blood cells (
Kushida et al., 2002
). Two bone
marrow needles were placed into a long bone (the humerus
gave the best results), one at the proximal end and one at the
distal end. The proximal needle was connected to a 30-ml
syringe containing heparin and the distal needle was con-
nected to a 30-ml syringe containing phosphate-buffered
saline (PBS). The PBS was infused gently into the medullary
cavity to flush the bone marrow into the heparin syringe.
