162: Evaluation of a Powered Intraosseous Device for Bone Marrow Sampling

Background: Our objective was to evaluate a powered bone marrow aspiration device for use in diagnosing disease and monitoring disease course and medicaltherapy.Patients andMethods:Thedevicewasused inaccordancewithpracticeguidelinesanddirectionsforuse. Data collection included insertion success, time to insertion and complications. Patient pain levels were rated 0-10 (10=extremepain).Deviceoperatorsratedeaseofuseofthe device 0-10 (10=outstanding). Results: There were 55 patients from three centers. Successful insertion and aspiration were achieved in 54 out of 55 patients (98.1%). Meaninsertiontimewas4.9±3.0seconds;significantlyfaster than that previously reported. There were no complications. The mean insertion pain score was 2.5±2.2 and the mean aspiration pain score was 3.7±2.5. The six operators rated the ease of use of the device at a mean score of 8.3±1.7. Conclusion: Findings suggest that the powered aspiration device is safe and effective for bone marrow aspirations. The importance of bone marrow examination in the evaluation of leukemia, multiple myeloma, anemia, pancytopenia and other disorders is well established (1-3). Bone marrow examination is also part of the staging process for newly diagnosed patients with lympho- proliferative diseases and certain nonhematopoietic malignancies, and is instrumental in determining the extent of marrow damage among patients exposed to radiation, drugs, chemicals and other myelotoxic agents. Moreover, marrow evaluation is essential to determine the efficacy of treatment and to monitor the recovery process in patients undergoing bone marrow transplantation or marrow- ablative chemotherapy (4, 5). There are two common methods of accessing the bone marrow for diagnosis and monitoring disease and treatment which usually involves two separate specimens: I) aspiration of the bone marrow for cytological preparation; and II) biopsy of the bone within the medullary cavity for a histological preparation. Cytological preparation of bone marrow allows excellent visualization of cell morphology (6, 7). Marrow in the diaphysis (shaft) of long bones is generally replaced by fat (yellow marrow) as the patient ages, rendering this site unsuitable for diagnostic aspiration. However, the red marrow that persists in the epiphysis (end portion) of adult bone may contain sufficient bone spicules to support reliable sampling. In adults, the sample is usually taken from the pelvic bone and in infants and small children (<2 years old) from the tibia. Most studies of multiple marrow sites have revealed marrow cellular content, cellular composition and pathologic al lesions to be mostly uniformly distributed through the bone marrow. The objective for this study was to evaluate the ability of a powered bone marrow aspiration device to penetrate the intraosseous medullary space of the iliac crest and to aspirate bone marrow samples for the ultimate purpose of diagnosing disease and monitoring the course of disease and medical therapy.