Painless Bone Marrow Biopsy: Anterior Approach with David Drew, MD

today we will introduce a new way of

doing bone marrow biopsy namely called

anterior approach this in has been

performed many many years ago mostly in

pediatric patients and right now this

technique is largely lost and the very

good point of doing this technique is

for very obese patient namely people

over 350 pounds it's difficult to

approach from the back axis but it's

very easy to approach from the front as

an important indication including people

on the vent ventilators they cannot be

turn prone so we have to do it in the

front and as some people COPD people

cannot lay flat we can do this position

in a hard sitting position most

important is to look at the structure

coming from the front is the same as

coming from the back just different

angle current into the same bomb st.

boom most important is to visualize

where to put in we try to palpate the

anterior ASIS and then we will put a

needle in this way get it going down

slightly follow inward to get into the

bounds very easy as soon as you get

comfortable with the position you can

easily get there when you touch the bone

you need to numb an area of a nickel

most often the practitioner numbed one

spot and their bone marrow pops in

either go to a different spot that is

the reason why so many people can pain

from it and also the track from skin to

the bone is actually a cylinder area

needs to be numbed it's not just a track

or thing track all right see here at

these steps I already touched the bunk

when you touch the bone there trabecula

s-- area the feeling is like putting a

ice pack ice pick on a pair of ice

that's the right feeling if you're going

too low hitting on the bomb cortical

bones you feel like you're hitting the

board that's the wrong area to get in

you leave the top of the bone is the

softest and it's easy with easiest place

to get in without causing any trouble

again let's visualize this spot over

here very well numbed is equivalent to

this spot over here and I will put a

needle from here shift angle a little


follow the track of the bone going down

to into the bone get into the hole you

feel again on top of the bone you feel

again look like a ice pick putting onto

the pile of ice not like putting into a

board and then you get a feeling of

angle start to drill

the drilling requires training okay I

get into it right now you feel that the

needles into the bone do you feel



verily the liquid coming out

and they're forming because they're

coming you can see that the angle over

here is already changed to this way

because of individuals anatomy structure

sometimes you have to get a feeling and

move it and in the first time I go this

way so I sleep off the bones I can feel

it I sleep off and I gradually gradually

turn the needle in this way right now I

can feel the needle is already turning

outward and I can get into the bones

okay today we showed the anterior

approach of the bone marrow biopsy and

how much pain do we have in the whole

process I just want to ask you almost no

okay and I didn't hear your screaming

again the most important portion of it

is to visualize getting here you may

have to adjust the angle even for me I

have been doing this for many many times

today I slipped it because this way so

later on I have to alter the angle to

this way to get into the bones and I

hope you can get something from this

little skill and help your patient thank