Bone marrow examination can understand the proliferation and development of bone marrow hematopoietic cells and the presence of abnormal cells, especially leukemia cells, which are of great importance for the diagnosis and differential diagnosis of hematological diseases. However, many patients are afraid of bone marrow aspiration (bone aspiration), mainly because they are afraid of pain, and refuse to undergo it despite painful persuasion, resulting in undiagnosed disease. In some cases, the patient reluctantly agrees, but often shivers and sweats profusely during the procedure. In fact, as long as you master the skills of puncture, bone puncture is not as scary as you think, I have summed up certain experience in the long-term operation process, can do basic pain-free, introduced as follows for sharing. 1, positioning: first set the site to be punctured, let the patient lie down, try to make him feel comfortable, more choose the posterior superior iliac spine, the patient to take the lateral or prone position can be, determine the puncture point, with nails to do cross indentation mark. 2, anesthesia: disinfect iodine volt at the puncture site 3 times, lay a cave towel, local anesthesia with 2% lidocaine, local anesthesia is selected in the center of the puncture site for intradermal injection, so that the injection needle bevel outward, the needle and the skin is about 15-30 degrees angle into the skin, and then the needle bevel and the skin parallel to advance, when the bevel completely into the injection, the formation of dermal mound, about 1cm in diameter, at this time the mound is urticaria-like or as Orange peel-like, intracutaneous anesthesia has been successful, and then pull out the needle, in the mound of the vertical needle to continue anesthesia, using the layer-by-layer anesthesia method, that is, into the needle → back to draw no return blood → injection, and so on, until the needle under the hard feeling can no longer advance, at this time has been to the periosteum, if the needle does not explore the hard feeling, then consider the positioning error, should be repositioned. The amount of drug injected in the periosteum should be more, also according to the patient’s feeling during anesthesia and pain tolerance, it is appropriate to inject 3-5 more points near the first point, especially for bone marrow biopsy or considering that the patient may have difficulty in operation, so as to avoid the patient’s pain when repeated puncture (because the puncture will be on another point). During anesthesia, ask if there is pain to understand the effect of anesthesia. 3, puncture: check the puncture needle for abnormalities and adjust the length of the needle, the left hand fixed puncture site, the right hand holding the puncture needle vertically into a certain depth, at this time there is a hard as stone feeling under the needle, indicating that the bone surface has been reached, if the needle to the estimated depth is still no such feeling, indicating that the skin of the puncture point changes, can be gently left and right to try to explore more and bone surface, to reach the bone surface when the force of the periosteum asked whether there is pain, if there is If there is obvious pain or the patient can not tolerate it, the anesthetic should be added, if mild pain can be tolerated or no pain can continue to puncture, rotate the puncture needle back and forth to advance, until the resistance is obviously reduced or there is a feeling of loosening that stop advancing, pull out the needle core, aspirate 0.2ml of bone marrow with a 10ml dry syringe, smear, in order to prevent dilution, the aspiration force should not be too violent, and leave a small amount of space at the front of the syringe to prevent too much suction. If other tests are needed, a certain amount can be taken again for examination. If the patient is in significant pain during the biopsy, the amount of anesthetic can be increased to reduce the pain. The needle is then removed, and pressure is applied to stop the bleeding and dressing. The above is a detailed explanation of certain key steps in the process of bone puncture, not the operational specifications, but purely personal experience, for reference only.