Lpn- central/picc lines

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    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 coarse no meds pushed.!! please someone help me wrap my head around this.. Is hospital policy legally practicing within scope? im so confused..
    Thnku

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  2. 24 Comments...

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    i hope that this helps.
    state & scope
    alabama - may administer meds and treatments under the direction of rn and perform hemodialysis if rn physically present to supervise. lpns must also have 2 years experience in initiating peripheral iv therapy for flushing central venous ports and changing fluid rate. must be under direction of physician or rn if adjusting dialysis treatment.
    alaska - may be delegated responsibly to administer iv meds and manage chronic dialysis care in a healthcare facility.
    arizona - may administer iv meds.
    arkansas - since iv therapy is not taught in pn education, lpns may only be delegated this task if they have a "postgraduate education and competency validation." they cannot provide any task that requires "specialized knowledge, skill or judgment of an rn." cannot perform hemodialysis.
    california - lvns with iv certification may start and superimpose iv fluids with vitamins, nutrients, and electrolytes by primary or secondary infusion lines. may also infuse blood and blood products, flush peripheral iv insertion site with heparin or saline. may not infuse antibiotics, or other medications via secondary iv line. may not infuse tpn or other fluids by central line. may not perform central line blood withdrawal. (source: http://www.vocationalnursingdirectorsofca.org/)

    colorado - lpns may perform iv therapy and venous blood withdrawal and administer "premixed antibiotic solutions via peripheral veins regulated by gravity flow or pump. cannot perform hemodialysis.

    connecticut - may initiate iv therapy, maintain continuous therapy and administer iv medication (except iv push meds) with special post-basic training, demonstrated competence and availability of ongoing supervision. cannot perform hemodialysis.
    delaware - may initiate and maintain peripheral therapy (including iv meds, except by push). limited central line activities. cannot perform hemodialysis.
    district of columbia - may administer iv meds and provide maintenance on ivs if: the "administrator of nursing services" has developed policies, procedures, and practice standards governing the practice of med administration by lpns and established specific criteria for use when approving meds for iv administration by lpns; the lpn has successfully completed an educational program for iv medication administration and has been evaluated and validated for clinical competency in iv med administration; and the lpn administers the approved meds under the general supervision of an rn. may not perform iv therapy in home care or residential care settings. may perform certain infusion therapy acts if the above conditions are met and has successfully completed an approved infusion therapy program approved by the bon. these acts include: administering pharmacy prepared medications; inserting heparin locks, including flushing with normal saline or heparin 100 units; providing venipuncture or withdrawal of a blood specimen from a peripheral catheter site; and change injection cap or iv tubing for peripheral lines only; inserting and discontinuing a pic that is no more than 3 inches in length; initiating prescribed iv fluids; calculating and adjusting iv flow rate, including infusion pumps; adding iv fluids to an established peripheral line. fluids must be non-medicated, commercially prepared or prepared by a licensed pharmacist. accepted fluids are limited to those fluids that are generally used as maintenance, and isotonic in nature. (source: district of columbia board of nursing)
    florida - may administer iv meds.
    georgia - no restrictions on lpns administering iv meds.
    hawaii - no written statement on iv and lpn scope.

    idaho - may hang: containers of premixed iv solution, blood or blood derivatives. may insert analgesic cartridges and program and monitor patient-controlled analgesia pumps. may perform autoinfusion. may monitor equipment, record readings and hemodialysis or peritoneal dialysis.

    illinois - though the practice act states lpns do not give ivp meds, it's "standard practice" that lpns with certification may give dialysis-specific iv meds. lpns are not allowed to co-sign or administer blood or blood products.
    indiana - no specific laws defining scope. nurses can "perform function that they are trained to do and those in which the facility allows them to do."
    iowa - after taking a board-approved course, lpns in hospital, ltc facilities and certified end-stage renal dialysis units may initiate peripheral iv therapy, administer premixed electrolyte and vitamin solutions, and premixed antibiotic solutions after the initial dose is administered by an rn.
    kansas - following "post-graduate training" lpns may administer: continuous iv drip analgesics and antibiotics, and, by direct iv push, analgesics, antibiotics, antiemetics and diuretics. cannot administer hemodialysis.
    kentucky - when delegated by rn, lpns may administer iv meds and fluids that are: mixed and labeled by an rn or pharmacist or commercially prepared; given on routine reoccurring basis to a patient with a stable condition. in terms of dialysis, lpns may collect assessment data; cannulate and perform dialysis treatment via implanted subcutaneous vascular device and/or peripheral access sites; administer heparin 1:1,000 units or less concentration; administer normal saline via dialysis machine to correct dialysis-induced hypotension based upon pre-approved medical protocol; administer iv meds (as stated in first sentence).
    louisiana - may: initiate and maintain iv therapy and administer iv meds by ivpb and/or ivp; perform heparinization during hemodialysis; care for clients with external venous catheters; obtain blood specimens; connect and monitor iv fluids, connect ivpb; provide site care.
    maine - lpns who have taken iv certification course may administer a heparin bolus as part of the procedure for initiating dialysis in a renal dialysis center.
    maryland - when rn on site or available by telephone, lpn may: perform iv medication administration which is routine for patient care; perform peripheral iv administration of medication using pharmacy-prepared medication; perform ppn solutions; and add medications to an iv solution.
    under direction supervision of rn, an lpn may: administer medication and tpn via a midclavicular or cvc by hanging pharmacy-prepared solutions; add medication to a solution administered via midclavicular or cvc; administer meds and subsequent replacement solutions including tpn via implanted ports. lpns may also administer standardized doses of non-vesicant chemotherapy agents and antiviral agents with proof of second specialized educational program completion. may not perform hemodialysis.
    massachusetts - may administer iv meds with exception of meds used during conscious sedation.may not administer hemodialysis.
    michigan - can give iv meds after they pass the "medication class" and receive a certificate. may not administer blood.
    minnesota - may administer iv meds.
    mississippi - may administer iv meds.
    missouri - may administer iv meds.
    montana - may mix medication solution for a unit dose vial and add to iv solution or volutrol; hang pre-mixed med solutions; administer metered dose of meds for patient-controlled analgesia pump; change standard solutions on continuous flow pre-established central line system. may perform following hemodialysis procedures under direct supervision of rn: arterio-venous fistula/graft needle insertion; prescribed local anesthesia as needed prior to dialysis needle insertion; assess, blood draws, flushes and dressing changes of hemodialysis central-venous catheters; administer prescribed does of routine dialysis heparin.
    nebraska - when under direction of rn, may infuse iv fluids and administer approved meds (by rn or md) into a continuous central flow line for adult patients. lpns may administer heparin, but no other iv meds in dialysis setting.
    nevada - lpns who have at least a year experience and completed a board-approved iv course may administer under written order or direct supervision of an rn or md, antibiotics or histamine h2 receptor antagonists by adding a solution by piggyback. may not administer hemodialysis.
    new hampshire - may administer iv meds and nutrients and the initial dose is administered by an rn. lpns may also add meds and nutrients to fluids previously premixed by a pharmacist or manufacturer after initial dose is administered by an rn. may not administer hemodialysis.
    new jersey - may be delegated task of initiating and administering ivs. may not start iv push meds or administer hemodialysis.
    new york - may add medications except chemotherapy to iv solutions for infusion through vascular access devises in an acute care setting under appropriate supervision. may not administer hemodialysis.
    north carolina -may administer iv fluids and meds through central vascular and peripheral vascular routes. may not administer hemodialysis.
    north dakota - may add prescribed meds to iv fluids to administer through existing peripheral lines and central venous lines having external access. may administer selected meds by iv bolus according to "specific institution policies and after specific institutional inservice." may administer iv meds and solutions during hemodialysis "after completion of specific institutional inservice and according to specific institutional policy."
    ohio - after completing board-approved iv course, may "initiate or maintain an iv piggyback infusion containing an antibiotic additive." if lpn meets above requirements, may also do the following dialysis activities at the direction of an md or rn: administration and regulation of saline solution for maintaining an established fluid plan; administration of iv heparin dose; administration of heparin dose peripherally via fistula needle; loading and activation of constant influsion pump or intermittent injection of med dose prescribed by dialysis md.
    oklahoma - may administer iv therapy and meds under supervision. may not administer hemodialysis.
    oregon - no mention of specific iv therapy tasks. may not administer hemodialysis.
    pennsylvania - may administer iv medication except for antineoplastic agents, titrated meds and iv push meds other than heparin flush. may not administer hemodialysis.
    rhode island - administering iv therapy and medication is within lpn's scope. may not administer hemodialysis.
    south carolina - select lpns may perform procedures and administer ordered treatments via peripheral and central venous access devices (under direct supervision of an rn) and lines if facility meets criteria for policy and procedures by the board of nursing. the lpn must also document completion of an iv certification course. the lpn may not begin blood, blood products/components hyperalimentation or chemotherapeutic agents. the lpn may not give medications directly into the vein (intravenous
    push). specific guidelines may be found at
    www.llr.state.sc.us/pol/nursing/forms/janfebmar2004newsletter.pdf
    south dakota - by peripheral route or externally accessed centrally placed catheter, may administer standard solutions at a defined flow rate, with or without admixtures, mixed and labeled by a pharmacist, rn or physician. may also administer vitamins antibiotics, corticosteroids and h2 antagonists mixed and labeled by a pharmacist, rn or md by iv piggyback, excluding first dose administration. may not administer hemodialysis.
    tennessee - the bon has taken the position that it's beyond the lpn scope of practice to be delegated the following tasks: administration of certain iv push medications, blood or blood products, experimental drugs or iv chemotherapeutic agents; insertion of pic or central lines. (source: tennessee board of nursing)

    texas - may administer iv meds both peripherally and via central lines. may not administer hemodialysis.

    utah - may administer iv meds after taking a post-graduate certification course. may not administer hemodialysis.
    vermont - iv therapy not addressed in scope of practice, but bon issued the following info. in a position statement (which isn't legally binding, but represents board's position on the matter): lpns have appropriate knowledge and skill to perform selected interventions in management of iv therapy if delegated and directed by an rn. these procedures include: initiating an iv using peripheral veins; monitoring and regulating infusion of prescribed iv solutions; monitoring patients' responses to blood and blood products; flushing peripheral intermittent devices with physiological saline or a heparin solution; and administering medication by intermittent infusion via peripheral lines. the following skills may not be delegated to an lpn: initiating a pca pump; administering medication via iv push or solutions via a venous central line (including picc lines); inserting central lines; drawing blood from a central or arterial line; administrating blood and blood products; changing a central line dressing; and mixing medications requiring reconstitution. lpns whose practice includes iv therapy management must have documentation of completing formal iv therapy program which includes a theory and clinical component; documentation of continuing competency; policies and procedures of healthcare agency supporting the practice of lpns in iv therapy; and resources necessary to provide "safe implementation" of these procedures. (source: vermont board of nursing)
    virginia - may administer ivs including all meds utilized in dialysis. cannot administer blood without an rn signature.
    washington - may administer iv meds and fluids under rn supervision after completing "appropriate continuing education and practice." may perform administration of fluids, meds, total parenteral nutrition, blood or blood products via central venous catheters or central lines, access these lines for blood draws and administration of emergency cardiac meds via iv push "if there are strict guidelines and protocols in place." may not administer hemodialysis.
    west virginia - can administer iv meds if delegated.may not administer hemodialysis.
    wisconsin - iv therapy, including administration of iv meds, "are considered either delegated medical acts or delegated nursing acts from an rn. cannot administer hemodialysis.

    wyoming - may administer iv meds after completing an iv therapy certification course. cannot administer hemodialysis.

    StinkMomBomb likes this.
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    Can I add to the above: NC Lpns can only do as stated above as long as the facility has a policy allowing them to do it, and the facility provides eduction on how to do it, and maintains competency training/validation.
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    I still don't understand, the OBN says through a "venous line" is a central venous line considered a VENOUS LINE, in which a LPN can

    1) Administer the following solutions through a venous line : (a) 5% dextrose and water;
    (b) 5 % dextrose and lactated ringers;
    (c) 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 likes this.
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    Its simple. Call them and ask. They will tell you. They have a practice consultant you can call anytime with questions to clarify scope of practice. They won't bite your head off.
    xtxrn likes this.
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    hospital policy & procedure manual ????????
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    hospital policy & procedure manual

    i agree! always know what is allowed by your state board, but also what the facility states you can do. sometimes facilities have more limited scope than what is legally allowed.
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    My hospital policy states that LPNS can administer fluids plain thru central lines and antibiotics, no drugs thru them though, and flush. Does this protect me thru the board?
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    Quote from Rico84
    My hospital policy states that LPNS can administer fluids plain thru central lines and antibiotics, no drugs thru them though, and flush. Does this protect me thru the board?
    This is a general comment about hospital policies vs. what the state nursing board allows.

    Hospital policies are made with the state's nursing practice act in mind. However, they may be vague, outdated and in outright conflict with what the state says is legal. A nurse may follow hospital policy to the T but still be held liable by the board of nursing for breaching a state rule.

    Also, nurses can be backed by the board of nursing's rules but still be fired by employers. For example, my professor once said that he supervised a nurse who was fired because she supposedly abandoned patients by leaving in the middle of a shift. The board disagreed but she was still out of a job. The state boards can't exactly make employers take nurses back.


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