Reply To: Day 4 Induction Discharge for pediatric patients with Acute Lymphoblastic Leukemia (ALL)

  • Carie Murphy

    August 16, 2021 at 10:57 am
    We usually place a port during BM biopsy & aspiration & LP with ITs.  If patient is doing well after PEG on Day 4 send home and they return for outpatient Day 8 procedure. Only readmit if fever.

    Carie Murphy, MSN, RN, CPN

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    Original Message:
    Sent: 8/16/2021 9:28:00 AM
    From: Emily Fulford
    Subject: Day 4 Induction Discharge for pediatric patients with Acute Lymphoblastic Leukemia (ALL)

    Hello All,
    We are currently conducting a quality improvement project to review the feasibility of Day 4 Induction Discharge for Newly Diagnosed Pediatric Patients with Acute Lymphoblastic Leukemia (ALL). Our current stardard is to discharge these patients on Day 8 after receiving pegaspargase, LP for IT MTX, and central venous line (CVL) insertion.

    At your centre, what is the current practice for newly diagnosed pediatric ALL patients in Induction therapy:
    1) Discharge on Day 4, Day 8, or keep to end of induction (this was our historical standard)?
    2) Has your centre moved to earlier Day of Induction discharge? If so, what day? What has been the experience with this change (i.e. any quick readmissions for F&N, CVL issues, side effects of chemo requiring readmission, etc.)?
    3) Wait until CVLs have been inserted before discharging home?
    4) Administer first dose of pegaspargase prior to discharge home?
    5) Do you ensure Day 8 LP is completed prior to discharge home?
    6) Ensure that new diagnosis teaching has been complete prior to discharge? If so, who does the teaching and when is this done? 

    Emily Fulford, NP-Pediatrics, MN, CPNP-PC
    SickKids – Leukemia & Lymphoma Program