Risk factors for complications:
(1) osteopenia or osteoporosis
(2) multiple myeloma or other disease of bone at the site of biopsy
(3) strong and vigorous collector
(4) inexperienced or poorly trained collector
(5) failure to clean the skin properly and failure to use aseptic technique
(6) use of a needle without a depth guard (failure to use a safe trocar)
(7) severe coagulopathy
(8) infant or young child
Complications:
(1) sternal osteomyelitis
(2) mediastinal abscess
(3) penetration of the heart and/or great vessels with hemopericardium and pericardial tamponade
(4) pneumothorax or pneumomediastinum
(5) excessive bleeding
(6) sternal fracture
Sternal puncture at or above the second intercostals space should be safer because the heart and pericardium are not as close as they are below this level. However, Bichel found that many complications occurred when this precaution was taken.
