A guide to performing a bone marrow aspiration

1. Decide on the most appropriate site for aspiration;

• The usual site for puncture in adults is the posterior superior iliac spine (PSIS).
• This may be technically difficult in obese or immobile subjects.
• The main advantage of this site is that a trephine biopsy can also be performed. Alternatively the sternum ( manubrium or 1^st or 2^nd parts of the body) can be used with care as there is a danger of  perforating the inner cortical layer and damaging the underlying large blood vessels and right atrium with serious consequences.

2. Obtain informed written consent;

• The procedure (in brief) and its main adverse effects (although rare) should be explained to the patient prior to obtaining consent.
• Pain, bleeding/haematoma formation and infection at aspiration site are the most commonly seen adverse effects, however, very rarely cause major concern.

3. Positioning the patient;

• Either left or right lateral decubitous on a bed/couch, with the dorsal surface of the patient facing the operator.
• Hold the hips and knees flexed to a comfortable maximum – knees drawn up and tucked into chest.

Venepuncture

Introduction Venepuncture is the term used for the procedure of entering a vein with a needle.

Indications

1. Withdrawal of blood for investigations
2. As a route for venous access

Procedure

1. Confirm patient identity   
2. Communicate with the patient
• Explain the procedure to the patient and get his/her verbal consent
• Try to minimize the patient distress
• Ask if blood has been withdrawn previously
• Sometimes the patient is able to point out sites where blood can be withdrawn successfully.
• Answer any questions the patient has  
3. Gather the equipment needed
• Non sterile pair of gloves
• Kidney tray
• Tourniquet
• Sterile alcohol swabs
• Sterile needle and syringe of an appropriate size
• Plaster / hypoallergenic tape
• Blood collecting tubes or bottles
• Ensure there is adequate light  

Technique of interpretation of plain radiograph of chest

CHECK LIST FOR PA FILM

Study the request form,

• Patient’s age sex, clinical information.
• Check serial number of radiograph against number on request form.

Technical aspects     

• Correct position of patient
• Area of interest - lung apices,lower neck, diaphragm, lateral chest walls. 
• Exposure factors.   

Chemical agents used in sterilization and disinfection

 

Liquids
Agent	Purpose ,  Antiseptic & Disinfectant activity,
1.    Alcohols 70% ethanol, 70% isopropyl alcohol (Up to 95% can be used but not in the pure form)	Kills – most vegetative bacteria, fungi & viruses Inactive against spores of bacteria & fungi 1.    Skin disinfectant for venepuncture, cannula insertion & IM injections. 2.    Disinfection of thermometers and surfaces. 3.    Can be used as a base for other bactericides. eg: Chlorhexidine, Iodine, Triclosan -  For pre-operation skin disinfection -  eg: 0.5% chlorhexidine in 95%  ethanol

 

2.    Aldehydes *Gluteraldehyde (Cidex) 2% gluteraldehyde is very commonly used in hospitals.

Kills – all organisms & spores 1.    2% Gluteraldehyde is used to disinfect heat sensitive instruments eg. Fiber optic endoscopes , Dialysis equipment,  Plastic tubing. 1.    Gluteraldehyde – inactivated less by organic matter. 2.    Need proper cleaning of instruments before dipping. 3.    Tubes must be totally immersed & completely filed. 4.    Non corrosive 5.    Irritant to skin, eyes & mucous membrane – need proper washing with sterile water after immersion. 6.    Acidic solutions are slower sporicides than alkaline solutions. 7.    Should be used within 14 days or discarded following 20 immersions even before 14 days.

*Formaldehyde

Decontaminate postmortem rooms, & laboratories.(fumigation)

 

Tendon Suture

Tendons are relatively avascular structures and heal by the in growth of connective tissue from the epitenon.

Indications

• traumatic injury to tendons
• as part of another procedure

Assessment

• Wounds in the vicinity of a tendon, assume tendon injury until it is shown to be intact on clinical examination
• If no action is demonstrated and there is doubt, explore the wound