Operative Technique

BMR OPTECH
Bone Marrow Regeneration
Preparation For Bone
Marrow Aspirate Collection
A Scrub Nurse or Theatre Assistant should prepare the
following items on a sterile tray:
Items Required:
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BMR Kit
20ml Syringe
Skin Prep
Swabs
Small Mallet
Steri-strips
Adhesive film dressing
0.5% Chirocaine
Using the 60ml syringe from the kit, draw up 3.5ml of Anti-Coagulant (ACDA) from the Vials in the kit. You must
now prime the needle: Remove the inner trochar of the bone marrow aspiration needle by twisting the middle
section of the handle then pulling this upwards. Inject 1ml into the top of the needle, which will run completely
through. Now replace the trochar. Remove BMR Chamber from packet.
Skin Prep
0.5% Chirocaine
Bone Marrow
Aspiration Needle
Small Mallet
Adhesive Film Dressing
Steri-strips
60ml Syringe
20ml Syringe
Swabs
Sterile Drape
1. Locate the Iliac Spine
If the patient is placed in the supine position feel to locate the ASIS. If the
patient is in the lateral position, locate the PIS. Mark it with a marker and
penetrate the skin with the bone marrow aspirate needle.
Gently advance the needle with a rubber mallet ensuring the correct
trajectory until the tip penetrates cancellous bone. Remove the inner
trochar to expose the syringe port. Attach the 60ml Syringe and gently
apply suction while twisting the T-handle 90 degrees in either direction
until bone marrow aspirate enters the syringe.
2. Aspirate Bone Marrow
Fill 60ml Syringe until the 35ml mark.
Once the syringe contains Bone Marrow Aspirate (BMA), it should be
gently swayed in a figure of 8 movement to ensure ACDA mixing.
3. Infiltrate Local Anaesthetic
Infiltrate local anaesthetic and close the wound with
steri-strips and a film dressing
4. Introduce Bone Marrow
Aspirate into BMR Chamber
The BMR chamber should be foil side up. Open the air vent by
lifting up one of the opaque white rubber caps. Remove the white
cap at the bottom of the chamber by twisting. The 60ml syringe
can then approach from underneath the chamber and attach to
the bottom of the chamber by the luer lock. Inject BMA (Max
35ml). Reapply the white cap with a twist until an audible click
is heard. Now close the opaque rubber cap and ensure both are
repositioned correctly.
ENSURE THAT THE CHAMBER REMAINS
WITH THE FOIL SIDE UP. DO NOT TURN THE
CHAMBER UPSIDE-DOWN UNTIL INSTRUCTED.
5. BMR Chamber 1st Spin
Weigh the BMR Chamber on the weighing scales and make the
same weight counterbalance by filling the loan chamber with
sterile fluid.
Place the BMR chamber into the centrifuge foil side up and
place the counter-balance chamber directly opposite.
Check the chambers can both swing to a full horizontal position
by gently tipping the foil side of the chambers towards the
centre of the centrifuge. If the chamber is catching on the
centre frame you can rotate the foil portion of the chamber in a
clockwise direction which will reduce the overall height of the
chamber. Spin @3200 rpm for 5mins.
6. Isolate Buffy and Plasma Layers
After spinning remove the chamber with great care so not to
mix the layers. If the layers are accidently mixed repeat the 1st
spin step.
The BMA is now separated into three distinct layers (top
to bottom); Plasma, Buffy Coat and Red Blood Cells. Screw
bottom of the BMR chamber anti-clockwise to push the middle
layer ‘buffy coat’ up into the middle (Plasma) chamber.
Turn lower section
anti-clockwise.
Plasma Layer
Buffy Layer
RBC Layer
Once Buffy Layer has
moved up into the
middle chamber stop
turning the lower
chamber.
Buffy Layer must be
at this exact level
7. Isolate Buffy/Plasma Layers
Now turn the upper half of the BMR chamber clockwise by
grasping the highest red ring with your thumb and forefingers,
and holding the middle and lowest red rings stationary with
your other hand. Turn the upper chamber clockwise until it will
turn no further (approx. 15 turns) You will see the white locking
bar move downwards into the top of the RBC chamber. The
buffy coat and plasma layers are now isolated from the RBC
layer.
TAKE CARE NOT TO OVER TIGHTEN
8. Set the BMA Concentrate Volume
KEEP THE CHAMBER FOIL SIDE UP FOR THIS STEP
Holding onto the upper red ring, turn the foil topped portion of
the chamber anti-clockwise until the inner white base reaches
the 2 CL line.
Gently swirl together the Buffy and plasma layers to mix them.
9. BMR Chamber 2nd Spin
Replace the BMR chamber into centrifuge foil
side down for the 2nd spin; 2300rpm for 5mins
10. Close Off BMAC Chamber
KEEP THE CHAMBER FOIL SIDE DOWN FOR THIS STEP
Now place one hand on the opaque rubber valves and one on the
lowest red ring. Turn the lowest red ring clockwise until it will no
longer turn. You will see the white locking bar move downwards
closing off the opening between the plasma and the BMAC.
Peel off the silver foil and using a syringed needle, draw off the BMAC.
11. Mix Artelocollagen and BMAC
Aspirate 2-5ml of BMAC in a separate 10ml luer lock syringe. Mix artelocollagen with BMAC using a 3-way tap.
Mix syringes approximately 16 times until the artelocoallagen and BMAC is thoroughly mixed.
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12. Preparation of the Fracture Site for Injection
Under image intensifier localise the fracture site.
Take a white needle (size 19) and connect it to a
10ml syringe with luer lock. Enter the fracture
site percutaneously. Once the needle position
is confirmed remove as much fibrous tissue as
possible with the tip of the needle to create space
for the injection of artelocollagen and BMAC
(if available for ease of injection, use a specially
designed syringe driver). On occasions, it may be
necessary to enter the fracture site from different
directions to achieve circumferential access. Keep
the white needle in place and remove the 10ml
syringe. Now connect the prepared 10ml syringe
containing the artelocollagen/BMAC mixture and
gently inject into the fracture site.
13. Apply a Pressure Dressing
To prevent outflow of the mixture, apply a pressure dressing with a wool
and crepe bandage. Mobilise and weight bear according to the stability of
the fracture fixation to the discretion of the treating surgeon.
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