骨髓穿刺活检

康尔福盛骨髓穿刺活检产品培训解剖骨膜、皮质骨、松质骨所需的骨髓液及骨髓样本就在松质骨骨膜有丰富的血管和神经，骨穿后疼痛就是因为刺激了骨膜里的神经所致。©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.骨髓穿刺活检的适应症©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.淋巴瘤急性白血病转移癌贫血骨髓抽吸液&骨髓活检样本骨髓液骨髓样本Hodgkin’s病诊断non-Hodgkin’s病诊断分期急性白血病诊断分期Hodgkin’s病诊断non-Hodgkin’s病诊断分期怀疑转移肿瘤确诊某些白血病诊断分期不明原因发热病因骨髓液量不足©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.骨髓穿刺活检WHAT?AspirationCore/Trephine/BMBiopsyWHERE?HaematologyLabHaematologyDayUnitsMinorproceduresPathologyOncology©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.WHO?HaematologistsPathologistsOncologistsSpecialistnurses骨髓穿刺活检部位

髂后上嵴-最常用-髂前上嵴肥胖患者髂后上嵴不好找胸骨仅能做穿刺入路简单，有一定危险需要有经验髂后上嵴胸骨髂前上嵴骨髓穿刺活检部位–儿童*Figure1六岁以下患儿Usetheflat,medialsurfaceoftheproximaltibialshaft(tibialplateau)1-2cmbelowthetibialtuberosityFigure2大于六岁患儿Usethemedialsurfaceofthetibia,proximaltothemedialmalleoluswherethecortexoftheboneandtheoverlyingtissueareboththinFigure1Figure2*如果髂嵴不可用©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.BoneMarrowProcedure©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.TheProcedure麻醉–皮肤©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.TheProcedure麻醉–软组织和骨膜©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.TheProcedure切口©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.TheProcedure穿刺抽吸©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.TheProcedure©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.穿刺抽吸TheProcedure活检©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.TheProcedure©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.活检TheProcedure取出样本©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.TheProcedure检查样本长度©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.康尔福盛公司产品268©2012CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.我们骨髓活检产品市场占有率全球第一骨髓穿刺抽吸针•圆形把手穿刺抽吸针◦DIN•T形把手穿刺抽吸针◦TIN©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.康尔福盛公司产品康尔福盛公司产品骨髓活检针•圆形把手Jamshidi针

DJ•T形把手Jamshidi针

TJC/TJM

TJM配备取样铲

©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.骨髓穿刺抽吸针骨髓穿刺抽吸针-TIN•髂嵴/胸骨穿刺抽吸，以及骨内注射•人体工程学设计的T形把手•限深器可拆卸•提供成人及儿童型号◦成人:◦儿童:TIN3015TIN3018©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.TIN–可拆卸限深器7.62cm1cm2.54cm4.76cm最小深度在位时最大深度移除限深器

移除限深器和底座©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.骨髓穿刺抽吸针-DIN•髂嵴/胸骨穿刺抽吸，以及骨内注射•限深器•帽子可旋掉

成人:DIN1515X

儿童:DIN1518X©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.•提供成人及儿童型号骨髓液涂片©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.骨髓穿刺活检针骨髓穿刺活检针--DJ•业界先锋•设计紧凑©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.DJ针尖设计•斜面切割•切割鞘刃口极其锐利

特殊设计减少对样本结

构的破坏©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.DJ样本获取及取出远端锥形设计•利于持住样本•最大程度保留样本的结构不破坏TJC—T型把手骨髓活检针

把手设计

有分量，手感好握持舒适©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.针尖设计6切割面(2betweeneachpoint)3切割嵴styletcuttingedges针芯与切割鞘的平滑过渡面3个切割点锐利的针尖，锚定穿透©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.Trocar针芯•金字塔形–单点接触•避免骨膜上的滑动•多出33%的切割面积•穿刺时少用25%的力量©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.冠状设计切割鞘•冠状设计-3点/6面◦快速有效的入针◦光滑的过渡面减少额外疼痛“减速带”疼痛©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.骨髓取样铲中空的样本推出杆把手末端膨出末端膨出，带指向箭头做毛的内表面槽:2.7cm壁厚增加30%2条槽把持样本©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.•末端带槽以及内壁拉毛处理把持样本•塑料的样本推出杆减少对样本的损伤•推出杆长1mm，利于样本完全推出•末端膨出便于把持操作•指向箭头避免样本丢失

内壁拉毛同轴设计可多次取样尖端斜面©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.骨髓取样铲骨髓活检样本Jamshidi骨髓穿刺活检技术TJC&DJ活检针

操作技术©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.TJM活检针操作技术©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.样本质量以及尺寸•通常需要2cm长•5-6个髓腔可见，没有明显结构破碎表现©2013CareFusionCorporationoroneofitssubsidiaries.Allrightsreserved.常见问题

皮质骨过多原因/对策•针芯移除过早–再来一次•用之前的针道–换个角度•操作技术不过关–再培训一次•针太细–换粗一号样本不够©2013CareFusionCorporationoroneofitssub