LPN Central / PICC Lines

[Rico84]

OK... I knew this would happen and I need advice.. So I just started my new position and I'm in the orientation phase, which is involving IV therapy training. I'm a LPN new grad and was in class today and the IV THERAPY RN NURSE came in and showed us how to put IVS in and change picc dressings. As she was finishing the picc lesson, she explained who can do what with piccs.. According to her, a LPN can hang IV NS or an antibiotic in this hospital per HOSPITAL POLICY. The OHIO board is beyond VAGUE and I want to know what to do!! I don't want to do something wrong, she also said I can flush a picc, but no draw backs and of coorifice no meds pushed.!! please someone help me wrap my head around this.. Is hospital policy legally practicing within scope? im so confused..

Thnku

[TheCommuter, BSN, RN]

i thought this as well but my hospital seems to be less restrictive.. my main question is what does venous access mean? i know peripheral venous and central venous access.. my bon says lpn can administer thru "venous" what would you say venous access means? :)

it means access through a vein. plain and simple.

some rns are specially trained to access arteries (radial artery, brachial artery, femoral artery, ulnar artery, etc.) for arterial blood gas draws, catheterizations, and so forth. this is arterial access, not venous access.

arterial access is way out of the lpn's scope of practice. venous access is within the lpn's scope of practice in most states.

[Rico84]

Just wanted to give an update regarding LPNS using central/picc lines. I emailed the board of nursing in ohio and got a reply. "Thecommuter" venous access means peripheral or CENTRAL access, it doesn't mean through a vein only. It is not "way" out of scope of practice for a LPN in this state. This is the response.

The regulations pertaining to LPN IV therapy are located in Section 4723.17, ORC, and Chapter 4723-17, OAC. A LPN who is IV therapy certified, acting under the direction of a RN or physician, may administer any of the approved solutions listed in Section 4723.17(D)(6)(a), ORC, and Rule 4723-17-03(B)(1), OAC, through a central venous line or PICC line. A LPN may inject heparin or normal saline to flush an intermittent infusion device or heparin lock. A LPN is not prohibited from flushing a PICC line that is being used intermittently with heparin or normal saline.

a) 5% dextrose and water; (b) 5 % dextrose and lactated ringers;

© 5% dextrose and normal saline;

(d) Normal saline;

(e) Lactated ringers;

(f) 0.45 % sodium chloride and water; or

(g) 0.2 % sodium chloride and water; or

(2) Administer any of the solutions set forth in paragraph (B)(1) of this rule that contain vitamins or electrolytes after a registered nurse initiates the first infusion of the solution containing vitamins or electrolytes.

[HazelLPN, LPN]

it means access through a vein. plain and simple.

some rns are specially trained to access arteries (radial artery, brachial artery, femoral artery, ulnar artery, etc.) for arterial blood gas draws, catheterizations, and so forth. this is arterial access, not venous access.

arterial access is way out of the lpn's scope of practice. venous access is within the lpn's scope of practice in most states.

actually, drawing labs off a lines and uacs was in my scope of practice as an lpn. there are a few states that allow lpns to do whatever they have been trained to do and they have few restrictions with the state bon, although the facility can restrict the practice. as far as starting an a line or drawing an abg without a line, the docs always did the former and respiratory did the latter....never an rn except for an advanced practice nurse.(nnps in the nicu were the ones you wanted to put the uac in your kid....vs the resident who might be out of practice).

best to you,

mrs h.

[Rico84]

thank you!:)

[TheCommuter, BSN, RN]

rico84 said:

just wanted to give an update regarding lpns using central/picc lines. I emailed the board of nursing in ohio and got a reply. "thecommuter" venous access means peripheral or central access, it doesn't mean through a vein only. it is not "way" out of scope of practice for a lpn in this state.

I was an lvn/lpn for four years (2006 to 2010) and accessed many piccs and central lines. these lines are located in veins, so they fall under the realm of venous access. picc lines and central lines are forms of venous access, not arterial access.

Quote

central line: a catheter (tube) that is passed through a vein to end up in the thoracic (chest) portion of the vena cava

Quote

a picc is inserted in a peripheral vein, such as the cephalic vein, basilic vein, or brachial vein and then advanced through increasingly larger veins, toward the heart until the tip rests in the distal superior vena cava or cavoatrial junction.

do you get it now? a picc line lies within a vein; therefore, this is venous access. a central line lies within a vein; therefore, this is venous access. I fully stand by my original answer.

https://www.medicinenet.com/central_line/definition.htm

https://en.wikipedia.org/wiki/Peripherally_inserted_central_catheter

[Rico84]

LOL.. good for you... But noone mentioned 'ARTERIAL ACCESS". So your original comment wasn't needed. I was looking for current LPNS to answer my questions.

[TheCommuter, BSN, RN]

LOL.. good for you... But noone mentioned 'ARTERIAL ACCESS". So your original comment wasn't needed. I was looking for current LPNS to answer my questions.

Please keep in mind that if you post something on a very public forum, you really do not have any control over picking and choosing the respondents (or the responses) to the discussions that you start. It would have also helped immensely if you had started this thread in the correct forum if you had only wanted input from current LPNs. You originally started this thread in the General Nursing forum. Therefore, half of the people who responded are RNs. The thread had to later be moved to the LPN Corner.

Not every single member is going to post replies that go exactly along with what you wish to hear. Not every single member is going to post a response that you believe is contributory or 'needed.' Thus, you always have the option of completely skipping the supposedly 'unneeded' posts or clicking on the ignore function. I wish you much success and professional development in your new job. In addition, I hope that you're successful with your second attempt at the RN program.

[jimthorp]

It's been my experience that generally speaking, the facility's scope of what you can do will be more limited than what the state says. However, to be sure, call or email your BON. If the Practice Act wording is vague and questionable (which does happen), email yourself a note about who you talked to, when, and the question you asked and what the answer is, just in case.

Not all BON's are created eual. I asked the PA BON a specfic question several years ago and they refused to provide an answer.

[Rico84]

really!! that would be weird, to ask the BON and they refuse on you. I recently asked if LPNS could take critical labs over the phone from lab, bc for some odd reason they don't let us at this hospital. They replied so quickly and said YES..its within our scope to accept a critical and notify the physician. Some of the rules are just odd.

[jimthorp]

really!! that would be weird, to ask the BON and they refuse on you.

I thought it was weird too. I even asked my state assemblyman for help. Still no answer from the PA BON.

Interesting though, they have pending legislation clariying the very issue I raised but it has sat idle or two years.

[Rico84]

what kind of question do you have?

[jimthorp]

what kind of question do you have?

I wanted to know if LPN's could access and maintain PICC lines. I had already read the NPA and nowhere was ANY VAD mentioned but the question was brought by up by many coworkers so I decided to go to the top for an answer and was turned away citing some legal drivel why they could not advise me even though the NPA says they can.