1. Place OrderIR consult for everyone, with specification as to what is needed (LP etc.) 
Myelogram request: also place with accompanying CT orders (cervical, thoracic, lumbar, etc) 

2. Call Neuroradiology PA-C at 578-9430 to discuss/review request 
we are always checking the IR queue for any new or recent orders but admittedly have missed a few depending on how the order is placed. So best practice would be to contact us so we are aware! 

Business Hours
The two APPs myelo/lp service and work M-F 7:00am-3:30pm.  With regard to hours, we lose our rad tech at 4pm and so any request for a procedure that comes in around that time will have to wait until the following day, unless of course it is deemed *stat* and then of course would become a call case.  

Requirements

• Plts/INR - within 72hrs is fine unless actively being anticoagulated on Coumadin or Heparin gtt or of course are thrombocytopenic, in which case we would want within 24hr
• Do NOT need a type and screen 
• Failed bedside attempt needs to be documented in powerchart, unless there is some limiting factor (patient size, lumbar scoli, previous surgery making landmarks difficult etc)
• Do not need to hold aspirin or dvt prophylaxis with subq heparin or lovenox
• Eliquis and xarelto are 3 day hold
• Plavix is 5 day hold 
• Patient does not need to be npo
• Please remember we prone patients to perform procedures so if not hemodynamically stable without use of pressers, might be best to consider stabilizing first before attempting to prone 
• We are not IR therefore we do not have an RN assigned to our room. 

Simply email Dr Vikas Agarwal, copy attending and all team members with a request for whatever procedure. 

If emailing about ESI/SNRB, include specific symptoms in your email. 

• Which Neuroradiology Team to Contact
• Protocols for APP Team
• Vik Agarwal