Sa Tech Lab 1 - Bone Marrow, Lymph Node, Arthrocentesis

Front 1

What is this called and what is it used for?

Back 1

Illinois Sternal Needle - bone marrow collection

Front 2

What is this called and what is it used for?

Back 2

Jamshidi needle, used for bone marrow collection

Front 3

what are 8 indications for bone marrow aspiration?

Back 3

1. non-regenerative anemia
2. cytopenias
3. abnormal peripheral circulating cells
4. staging of neoplasia
5. infectious disease Dx
6. evaluation of FUO
7. evaluation of hypercalcemia
8. evaluation of paraproteinemia

Front 4

what are 4 advantages of bone marrow aspiration

Back 4

1. technically easy
2. well tolerated
3. accessible tissue in patients with bleeding disorder
4. anesthesia not required

Front 5

what are 5 potential complications of bone marrow aspiration

Back 5

1. bleeding/hematoma
2. iatrogenic trauma
3. iatrogenic infection
4. post-operative pain
5. failure to obtain sample

Front 6

what are the two types of bone aspiration needles?

Back 6

1. Illinois Sternal Needle
2. Jamshidi needle

Front 7

what are the four preferred sites for bone marrow collection in the dog?

Back 7

1. humeral head
2. iliac crest
3. trochanteric fossa of femur
4. sternebrae (rare)

Front 8

what type of needle is used most commonly to collect bone marrow biopsy samples?

Back 8

Jamshidi needle

Front 9

what are three indications for bone marrow biopsy?

Back 9

aids characterization of lesions causing:
1. marrow replacement
2. marrow infiltration
3. aplastic or hypocellular processes

Front 10

what are four indications for lymph node aspiration?

Back 10

1. lymphadenopathy (inflammation, hyperplasia, neoplasia)
2. staging neoplasia
3. hypercalcemia
4. FUO

Front 11

what are five advantages of lymph node aspiration?

Back 11

1. no sedation required
2. inexpensive
3. rapidly and easily performed
4. tissue accessible
5. minimal complications

Front 12

what four lymph nodes are commonly aspirated on the dog?

Back 12

1. submandibular
2. superficial cervical (prescapular)
3. popliteal
4. inguinal

Front 13

what are two different methods for lymph node aspiration?

Back 13

1. Syringe method (e.g. with an Aspergun™)
2. Woodpecker method

Front 14

what are four ways in which joint fluid is analyzed?

Back 14

1. gross
2. cytologic
3. biochemical
4. microbiologic

Front 15

what are five GENREAL indications for arthrocentesis?

Back 15

1. joint pain
2. joint effusion
3. radiologic evidence of arthropathy
4. FUO
5. vague lameness

Front 16

what are four SPECIFIC indications for arthrocentesis?

Back 16

1. monoarthropathy (trauma, sepsis, neoplasia)
2. polyarthropathy (infectious, immune mediated)
3. contrast arthrography (infrequently used)
4. intra-articular drug delivery

Front 17

what are three basic etiologies for monoarthropathy?

Back 17

1. trauma
2. sepsis
3. neoplasia

Front 18

what are two basic etiologies for polyarthropathy?

Back 18

1. infectious
2. immune-mediated

Front 19

how much fluid does the normal canine joint have?

Back 19

< 0.5 mL

Front 20

what is the basic procedure for bone marrow aspiration?

Back 20

1. lateral recumbency w/ restraint
2. palpate anatomic landmarks
3. surgical sterile prep
4. prior to final scrub, lidocaine in skin
5. sterile gloves (and drape optional)
6. aseptically draw 2 mL EDTA into a 12 mL syringe
7. remove stylet from aspiration needle, attach syringe, and flush EDTA through needle onto a Petri dish. Remove syringe and replace stylet
8. 3-mm stab incision into bone marrow site
9. with stylet in place, advance needle and bore through bone
10. when cortex is penetrated, remove stylet and attach syringe
11. aspirate
12. detach syringe (leaving needle in place) and eject contents onto Petri dish containing EDTA
13. remove needle

Front 21

what is the most painful part of the bone marrow aspiration procedure?

Back 21

aspiration of the bone marrow

Front 22

what is the appearance of aspirated bone marrow?

Back 22

dark red, fat particles, more viscous than blood

Front 23

how do you avoid dilution of bone marrow with peripheral blood?

Back 23

aspirate < 1 mL of marrow

Front 24

what are the 3 ways that bone marrow aspirate can be processed after the sample has been placed on the Petri dish with EDTA?

Back 24

1. 20-30+ slides
2. inoculation into a culturette
3. remaining fluid into an EDTA (lavender) tube

Front 25

to obtain a bone marrow biopsy, and the needle is through the cortex, what is the procedure?

Back 25

1. loosen sample by alternate rotation and wobbling of needle
2. partially withdraw, redirect, and advance
3. repeat step 1

Front 26

after a bone biopsy needle is removed from the patient, how is the sample obtained from the needle and processed?

Back 26

- in retrograde fashion (needle to hub), advance obturator
- place biopsy into fixative

Front 27

what is the basic procedure for the syringe method lymph node aspiration?

Back 27

1. restrain patient and isolate lymph node
2. needle (with or without aspiration gun) into lymph node
3. negative pressure and redirect; repeat negative pressure
4. release negative pressure
5. withdraw needle
6. detach needle from syringe, fill syringe with air, expel contents onto microscope slide

Front 28

what is the basic procedure for the Woodpecker method lymph node aspiration?

Back 28

1. restrain patient and isolate lymph node
2. introduce needle without attached syringe
3. withdraw and redirect several times
4. remove needle from lymph node
5. expel onto slide with air-filled syringe

Front 29

what are three complications of arthrocentesis?

Back 29

1. cartilage damage
2. iatrogenic infectious arthritis
3. iatrogenic hemarthrosis

Front 30

why is sedation or anesthesia used for arthrocentesis?

Back 30

1. reduce risk of cartilage damage (patient movement)
2. reduces risk of patient hemarthrosis
3. normal joint capsule is extensively innervated with nociceptors
4. if there is effusion, it is always painful

Front 31

what part of the carpus is easiest for arthrocentesis?

Back 31

radiocarpal joint (craniomedial aspect of carpus)

Front 32

how is the limb held and landmark found for radiocarpal arthrocentesis?

Back 32

flex carpal joint and palpate for depression over the craniomedial aspect of radius

Front 33

what vascular structure should be avoided when doing a radiocarpal arthrocentesis?

Back 33

superficial branch of cephalic vein

Front 34

if there is effusion in the elbow joint, which pouches are most commonly swollen?

Back 34

caudolateral and craniomedial pouches

Front 35

what is the typical site of arthrocentesis of the elbow?

Back 35

caudolateral pouch

Front 36

how is an arthrocentesis of the caudolateral pouch of the elbow performed?

Back 36

- caudolateral pouch is between the lateral humeral epicondyle and the olecranon
- place needle just lateral to triceps tendon
- direct needle caudolateral → craniomedial to avoid contact with the anconeal process

Front 37

how is the patient positioned for shoulder joint arthrocentesis?

Back 37

lateral recumbency, affected limb up, joint mildly flexed

Front 38

how is an arthrocentesis of the shoulder joint performed?

Back 38

- lateral recumbency, affected limb up, joint mildly flexed
- palpate point of greater tubercle and acromion
- needle should be placed so it passes just lateral and proximal to the greater tubercle in the craniolateral to caudomedial direction

Front 39

in which joint pouches is stifle joint effusion usually located?

Back 39

medial and/or lateral parapatellar areas

Front 40

how is the patient positioned for stifle joint arthrocentesis?

Back 40

lateral recumbency, affected limb up, joint mildly flexed

Front 41

how is an arthrocentesis of the stifle joint performed?

Back 41

- lateral recumbency, affected limb up, joint mildly flexed
- palpate patella, patellar ligament and tibial tuberosity
- needle can be placed medial or lateral to the patellar ligament
- divide the distance from the patella → tibial tuberosity into thirds; place needle in DISTAL two-thirds
- direct needle slightly proximally, toward the center of the joint

Front 42

why can successful aspiration of stifle joint fluid be difficult?

Back 42

soft tissue structures in the joint (fat pad, ligaments)

Front 43

what are two sites of approach for tarsal arthrocentesis?

Back 43

1. craniolateral
2. caudolateral

Front 44

how is the needle directed in the craniolateral approach to tarsal arthrocentesis?

Back 44

direct needle between the lateral malleolus of the fibula and the talus

Front 45

how is the needle directed in the caudolateral approach to tarsal arthrocentesis?

Back 45

needle directed distally, attempting to penetrate opening between tibia, fibula, and tarsus