Reply To: LP/Bone Marrow Privilege’s for APP’s

  • Karina Engelke

    April 25, 2022 at 4:43 pm

    Hello Melissa,

       I am in CT and I perform LP with IT chemo, Bone marrow aspirates and biopsies, and intra ommaya taps with chemo without an attending present, though one is always available for back up.

    Our Procedures are done in our sedation suite with one of our sedation team attendings and one hem/onc nurse and one sedation nurse present, or they are done in the OR. I perform them when working both inpatient and outpatient.


    Karina Engelke, RN, MSN, APRN, CPNP, CPON

    Connecticut Children’s Medical Center

    Division of Pediatric Cancer and Blood Disorders

    Hartford, CT 06106


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    Original Message:
    Sent: 4/25/2022 4:35:00 PM
    From: Jennifer Toth
    Subject: RE: LP/Bone Marrow Privilege’s for APP’s

    Hi Melissa- 

    I do both inpatient and outpatient, and I am able to perform LPs (+/- IT chemo), bone marrows, and Ommaya taps without an attending present (although one is always available and often is present). Our procedures are almost all done in the sedation suite with a PICU MD and sedation nurse present. Our outpatients need a visit with H&P done prior to sedation, which can either done by me or an attending.

    Jennifer Toth, MSN, CPHON, CPNP-AC
    Nurse Practitioner
    Pediatric, Adolescent, and Young Adult Hematology/Oncology
    MedStar Georgetown University Hospital
    Washington, DC
    Original Message:
    Sent: 04-25-2022 03:11 PM
    From: Melissa Diaz
    Subject: LP/Bone Marrow Privilege’s for APP’s

    Hello to all,

    Question I’ve been asked to investigate from my providers. My current “delineation of privilege’s” from my local healthcare system in FL allows me to perform lumbar punctures, administer intrathecal chemotherapy and perform bone marrow biopsies/aspirates without a heme-onc physician present in the room. My physicians are available on the unit (very small/12 bed outpatient unit), in the event I need back up. So typically, it is the APP, x1 RN and the Pediatric Intensivist administering procedural sedation in the treatment room w/ full monitoring. On rare occasions, we do perform procedures in the inpatient setting as well (24 bed unit).

    Question is:
    1. Do APP’s perform LP’s/bone marrows in your healthcare setting (inpatient and/or outpatient)?
    2. If so, do you perform these procedures independently, without a heme-onc physician in the room?
    3. Is the patient seen by the heme-onc physician prior to or following the procedure? If so, that % are seen prior to the procedure?

    Thank You all for your help!

    Melissa Diaz, APRN-BC, CPHON
    Joe DiMaggio Children’s Hospital
    Hollywood, FL

    Melissa Diaz, CPHON,FNP,MSN
    Davie, FL
    United States