Powered Bone Marrow Biopsy in Daily Practice: Integrating System Design Features Into Institutional Workflows

Bryon Allen: I'm Bryon Allen. I'm a nurse practitioner. I've worked in hematologic malignancies and stem cell transplant for over 20 years at a major academic institution in Portland, Oregon. And I'm joined by my colleague Jeremy Heinerich today.

Jeremy Heinerich: Hello, my name is Jeremy Heinerich, and I'm a physician assistant. Been practicing for over 25 years in oncology with a primary focus in procedure clinics and procedural spaces. And I work at three major academic centers in New York City.

Bryon Allen: So, bone marrow biopsies: they’re central to diagnosis, staging, and monitoring of hematologic malignancies, and a procedural approach influences both the operator experience and the diagnostic outcomes. Powered bone biopsy systems incorporate design features that may shape both the operator experience and integration into institutional workflows. The design of the BD Trek Powered Bone Biopsy system includes variable-speed control, a scored needle, and ergonomic considerations. Understanding how these features translate into procedural experience and workflow efficiency may help inform device adoption and standardization into clinical practice. Jeremy, looking back on your institution's transition to the BD Trek Powered Bone Biopsy system, what's the biggest adjustment, and how did it influence the way you perform bone marrow biopsies today?

Jeremy Heinerich: So, coming from the manual, the biggest adjustment was the perception that there was reduced tactile feedback. I had to trust that the system's mechanism, rather than the field that I was used to, and that's a real learning curve, and I think that's worth being honest about with your colleagues from the start. But the other thing for me as well was the financial aspect of it because it was a little bit more expensive than the manual needles that we were using. But once we overcame that and I started using it more and I noticed that I was having better sample selection, better feedback from patients, it really won me over. And so now my challenge is getting other colleagues within the institution to adopt to it as well.

Bryon Allen: One thing I realized is once I became comfortable with the BD Trek driver, I began using what I call the myeloma technique on patients with softer bone. Over time, it became a routine part of my practice and my procedure workflow, and it helped me achieve the sampling objectives I was looking for. I actually train all of our APP colleagues and also our MD fellows to do bone marrow biopsies, and I let all of them know about the techniques so that they can help them get some of those more challenging, softer bone biopsies to be more successful.

Jeremy Heinerich: So, one feature of the BD Trek Power Driver that I incorporated into my technique is the variable-speed trigger. It allows me to use lower speeds when gaining access or navigating more challenging anatomy and higher speeds when collecting a core or working through a denser bone. The scored needle design of the BD Trek Biopsy Kit is intended to facilitate sample retention during core extraction. And in my practice, performing multiple manual bone marrow biopsies can be physically demanding. And after transitioning to the BD Trek Power driver, I noticed the procedure required less physical effort compared with the previous manual approach.

The rotational drilling may support consistent cortical penetration and needle advancement, though clinical observation in this area has not been formally studied in the published bone marrow biopsy literature. So, powered bone marrow biopsy systems have been studied in clinical settings across academic medical centers and have demonstrated the ability to obtain diagnostic-quality specimens with operators, including physicians, physician assistants, and nurse practitioners.

The trephine bone marrow biopsy is recognized as a painful and anxiety-provoking procedure with no standardized pain management approach across institutions. Device design features that support procedural efficiency may contribute to the overall patient experience. So Brian, what has your experience using the BD Trek Power Driver influenced how physically demanding the procedures feel compared with your manual approach?

Bryon Allen: On days with multiple procedures, the reduced physical effort with the BD Trek Power Driver is noticeable. I mean, it helps me maintain a consistent technique throughout the day, particularly with denser bone marrows. And this goes for when you're going back-to-back-to-back procedures; it's just much more consistent and can get the quality specimen you need for pathologists to get the information they need.

Jeremy Heinerich: So I noticed the reduced physical strain using the BD Trek Power Driver, but the bigger adjustment was ultimately in operator technique. The way you utilize the variable speed and auto-braking is different from anything you do manually, and it takes deliberate practice to get comfortable with it. So I think one of the challenges, again, is getting people to overcome the fear of losing control when they use this device.

Bryon Allen: Standardizing training and competency frameworks for APPs performing bone marrow biopsies support consistent procedure quality and successful technology integration across practice settings. We actually have a process now: if there's sub-quality bone marrow, we're keeping track of it, so we can trace it back and work backward to see what the issue is. Is it a training perspective from the provider, or is there something else going on with our systems? Clinicians transitioning from a manual technique or to a powered system often experience a period of adjustment, which should be noted. Becoming familiar with the system's control features, ergonomics, and workflow requirements can help support successful adoption, integration into clinical practice. In my experience, we've transitioned from a powered system to the BD Trek Powered Bone Biopsy system, and definitely the variable speed control was a big improvement for me. It allows that subtle introduction initially and increasing the speed later on when you're going for that core or getting into the bone marrow space.

So Jeremy, when you introduced the BD Trek Powered Bone Biopsy system in your practice, how did you approach training and the broader considerations that come with adopting a powered bone biopsy system?

Jeremy Heinerich: So when you introduce any new system, whether it's from a manual or from another powered platform, it involves institutional inertia. Training takes time, habits need to change, and not everyone adapts at the same speed. Planning for that nuisance factor upfront makes the integration smoother. And another consideration is the difference in tactile feel between manual and power during cortical penetration.

Bryon Allen: For us, in our experience, onboarding took some time, but the key was to build in our standard workflow rather than treat it as a special case tool. Once it was the default approach, the team's comfort level rose quickly. Considerations should be given to vendor support and internal training as a new system set up could impact learning curve or a new workflow. Our rep coming out and supporting the new providers onboarding to using the BD Trek Powered Driver system definitely helped increase their confidence with using the device and made successful approaches much more rapidly to occur.

Jeremy Heinerich: So, some closing takeaways. Once we introduced the BD Trek Power Driver into our practice, we gained a greater appreciation for how design features, training, and workflow integration can influence the overall bone marrow biopsy procedural experience. Powered bone marrow biopsy has been evaluated across academic medical centers with studies demonstrating that diagnostic quality specimens can be obtained when procedures are performed by trained clinicians experienced in bone marrow biopsy. How clinicians use specific control features in daily practice represents an important dimension of operator experience that has not yet been fully captured in the published literature. Consistent procedural approach informed by familiarity with system design features and supported by institutional training contributes to diagnostic quality and workflow efficiency. So for clinicians considering the adoption of the BD Trek Powered Bone Biopsy system, what advice would you offer them based on your experience, Bryon?

Bryon Allen: Most meaningful shift for me has been consistency. Once our team is trained on the powered system, we're able to approach procedures with greater predictability, and that reliability is something I'd emphasize to anyone considering adoption. Giving those consistent, adequate specimens that make pathologists able to give the information we need to diagnose, treat, and monitor our patients is required.

Jeremy Heinerich: So my advice is to go in with realistic expectations around the transition period, whether you're coming from manual processes or a different powered system, there's always a learning curve, and getting institutional buy-in takes time. I think one other thing that I will share that it's helpful to share with people that are considering this is to listen to the patient feedback as well, once they've had successes with this. Again, I find this to be very helpful in those myelofibrosis patients that have really hard bones or even the young patients that have really hard bones, you don't have to push as hard and so they don't feel that as much. A lot of our patients, they want a second core, and so I'm able to just go a little further with the BD Trek system and then I just cut the sample in half, whereas previously I might have to go in twice with the manual needle.

So I think that also saves some time and efficiency for the patient as well too, because you're able to get the procedure done in a quicker process and not have to go back in again. So I think that's a key thing as well. And again, just like when you're doing this on a patient, managing their expectations and helping them to understand what's happening, explain the process, try to create a calm and relaxing environment for them, and explain to them as you're doing the procedure. I think that's also stuff that is very important to allow the procedure to be successful, and then the patient not be so afraid of doing it in the future.

Bryon Allen: I agree. Walking the patient through the procedure definitely helps them get through it and manage it easier. And I've definitely heard from patients in my practice that we have patients that come to our clinic because we have the powered driver, where they could have this procedure done at their local oncologist’s office, which may be hours away. However, they use the manual system, and because of the discomfort with that versus what they experience with the BD Powered Driver system, they'll come to our institution to have it done there.

1. Marinelli LM, Fang H, Howard MT, et al. Bone marrow biopsy operator experience and impact on aspirate, biopsy, and ancillary testing quality. Mayo Clin Proc Innov Qual Outcomes. 2018;2(3):241-247. doi:10.1016/j.mayocpiqo.2018.06.007 
2. Merzianu M, Groman A, Hutson A, et al. Trends in bone marrow sampling and core biopsy specimen adequacy in the United States and Canada: a multicenter study. Am J Clin Pathol. 2018;150(5):393-405. doi:10.1093/ajcp/aqy066
3. Glennon CA, Woodroof JM, Kambhampati S, et al. Comparison of bone marrow biopsy specimens obtained using a motorized device and manual biopsy systems. Asia Pac J Oncol Nurs. 2018;5(4):394-398. doi:10.4103/apjon.apjon_26_18
4. Nadda R, Repaka R, Mallik N, Sahani AK. A prospective survey on trephine biopsy of bone and bone marrow: an experience with 274 Indian patients’ biopsies. Eur J Med Res. 2023;28(1):193. doi:10.1186/s40001-023-01167-7
5. Liptrott SJ, Botti S, Bonifazi F, et al. Management of pain and anxiety during bone marrow aspiration: an Italian national survey. Pain Manag Nurs. 2021;22(3):349-355. doi:10.1016/j.pmn.2020.09.005
6. Lord K, Toth S, Potter J, et al. Development of a standardized bone marrow procedure training and competency toolkit for advanced practice providers in a large community oncology practice. J Adv Pract Oncol. 2022;13(7):713-716. doi:10.6004/jadpro.2022.13.7.7