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   Generally speaking, puncture has pain when the needle passes through the skin, which is one. Secondly, the nerves of the bone are mainly distributed on the periosteum, and the patient will inevitably feel pain when the needle is punctured into the periosteum. In the above two cases, the local anesthetic can be applied to the periosteum of the skin when the doctor preoperatively administers local anesthesia to the patient to solve these pain problems. The third pain is unresolvable pain, the kind of pain that generates negative pressure when the needle enters the bone marrow cavity and draws out the bone marrow. In order to relieve the patient's pain at this time, the doctor needs to pump slowly.

How much    draw depends on the specific case. In some cases, one milliliter can be withdrawn to extract the bone marrow, and some may not. A simple bone marrow smear can be done without taking too much. If you want to do additional tests such as breeding genes, you must draw more points, using a large syringe or even a 20 ml syringe.

  The assistant stood opposite the doctor in charge of the puncture, helping to observe the patient's condition, lay hands, and help make bone marrow smears. Bone marrow smear is a drop of bone marrow drawn on a glass slide, which is somewhat similar to the plant leaf slide made in middle school biology class. Like today, this child needs to do more than five slides when he is diagnosed for the first time.

  Tian said to the students: "Compared with other puncture procedures, bone puncture has less risk, so don't be nervous."

   Teacher's words can be understood in this way. To extract bone marrow, you must find the big bones in your body to extract. The bone target is large, unlike deep vein puncture, which requires tying deep, thin and smooth blood vessels, like a blind man touching an elephant. Lumbar puncture is difficult and high-risk. It has been said before that inadvertently drawing cerebrospinal fluid will affect the patient's brain.

  If the bone is pierced, the bone that can be touched through the skin is easy to place with one stitch, the probability of error is small, and the risk of complications is also small. Moreover, there are many optional targets for bone piercing for doctors. If this bone cannot be felt or can't be extracted, you can find another bone to extract.

   Usually clinically, bone piercing can extract the sternum, ilium and tibia. It is best to wear the iliac bone, and the marrow in the large bone marrow cavity of the iliac bone is more likely to be pumped. Children under six months have more tibias, and the puncture position of the tibia is relatively safe.

   In view of the high risk of sternum puncture, and for safety reasons, the doctor did not dare to take the risk of the sternum after thinking about it, and directly chose the iliac bone that everyone likes the most. The anterior superior iliac spine or the posterior superior iliac spine can be selected for the iliac needle insertion point.

   Zhang Desheng had previously practiced in the Department of Hematology of the Chinese National Association. He had seen the teacher perform bone piercing and also gave him a hand. For this reason, Teacher Tian appointed him to do puncture. Zhao Zhaowei acts as an assistant.

   Several surgical students who had never been to the National Association of Hematology Department were watching on the sidelines. What is more special is Xie, who was named by the family of the patient to take care of the child, standing next to the puncture doctor to help hold the child.

   For any puncture operation, it is most important to accurately locate the anatomical position of the puncture target.

   Zhang Desheng touched the child's ilium with his sterile gloved fingers, and asked Xie Xie with his eyes, "Is the position I touched right, Yingying?"

   As we all know, Xie is a super scholar in anatomical positioning. Smarter classmates will seize the opportunity to seize Xie Xie's opinion.

  The child's position is supine, Xie Wanying deduced from this that the classmates may want to insert the needle from the anterior superior iliac spine, saying: If you are not too sure about the puncture, it is better to choose the posterior superior iliac spine. The posterior superior iliac spine is larger than the anterior superior iliac spine and easier to puncture. If you are afraid that the position of the child with the posterior superior iliac spine is difficult to fix, we will assist you.

   (end of this chapter)