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

  • Erin Connelly

    April 28, 2022 at 12:59 pm

    Our APPs perform LP w & without IT; bone marrow aspirates and biopsies both inpatient and outpatient.


    Outpatient is in our sedation suite and no hem/onc MD in the room-unless help is needed. A hem/onc MD will not see the patient, before or after the procedure, unless the patient is being admitted and thus required to be seen by an Attending. Otherwise the entire visit is completed independently by an APP.



    Same on the inpatient side-APPs perform 99% of the inpatient procedures and again 98% of the time there is no hem/onc MD present.


    Hope this helps.




    Erin Connelly APRN, CPNP, CPON

    Developmental Therapeutics Nurse Practitioner/Clinical Manager of Advance Practice

    Aflac Cancer & Blood Disorders Center @ Scottish Rite

    Children’s Healthcare of Atlanta

    404.785.0906 (office)

    404.785.3511 (fax)

    678.372.3768 (cell)


     A close up of a sign  Description automatically generated

    This message may contain legally confidential and privileged information and is intended only for the named recipient(s). Only a named recipient is authorized to read, disseminate, distribute, copy, or otherwise disclose the contents of this message. If you have received this message in error, please notify the sender immediately by e-mail or telephone (404.785.1200) and delete the message in its entirety. Thank you.


    Original Message:
    Sent: 4/25/2022 4:11:00 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