Can I.V. certified LVN's hang "K-RIDERS"?

[mssrf]

I am in the state of California and this question comes up among my peers, instructors and co-workers. If you are a I.V. Certified "LVN" can you hang a K-rider? Since potassium is an electrolyte some say yes but most say no because it is considered as an

like an I.V. push drug which LVN's cannot do. Potassium also has its dangers with heart arrhythmias when being administered.

I am a new grad from Vocational Nursing School and this is one of my make-up assignments.

Is there any Board Certified help out there? Any RN's or I.V. instructors who can help? This question only applies per California Law. Thanks!!

[BarbPick]

Lpns can hange anything except blood, which they can check, if an RN is supervising on the same floor. Independantly, like Home Health, they are not allowed to add any medication to an infusion, it has to be pre made or a vial that was attached at a pharmacy, they can break the little plastic gizmo and reconstitute the drug in the piggy back. They are only allowed to push saline and hep lock solution. If a patient need IV Lasix, it has to be put in a 25 or 50 cc bag and given that way by an LPN.

[mssrf]

I am polling The Supervising "RN's" from different hospitals here in California and so far I am told "LVN's" cannot under any circumstances hang K-riders.

Anybody else out there that can help me from California?

[featherzRN, MSN]

Don't know about the official word, but at my last job (we don't have LVN's where I am now), an LVN could hang blood (with an RN to double check the ID) and premade IV fluids with low dose e-lytes (including banana bags). . No K-riders or any other type of piggyback was allowed.

[jnette, ASN, EMT-I]

This certainly does vary from state to state.

Where I live LPN/LVNs do hang blood ...all the time. As well as do IV pushes, and everything the RN does with the exception of initial pt. admission assessments.

So you would be wise to inquire specifically of California, as you have mentioned. :)

[mssrf]

Thanks for all the responses...Can you tell me the city and states you are responding from when replying.

I am trying to find out the calif. Law or protocols versus other states/countries..Etc

This is all helpful to me and I really appreciate all of the knowledgeable "Rn's" out there. Any pharmacists?

Instructors? State board personnel?

[BarbPick]

I am from Miami, but what does that have to do with IV's and the Florida Nurse Practice Act?

[mssrf]

The reason I inquired to the states the answers are coming from is because california law governing lvn/lpn's are not the same as laws in other states. I wanted to know if anyone in calif or anyone who knows the calif protocol on this question could give me the answer/rationale since

This question is one that is slightly different even from hospital to hospital here in calif.

A couple of hospitals that I called here in southern calif responded that if the lvn is iv certified under the supv of the rn on the floor
A k-rider can be hung. However, the hospital where I work told me they weren't sure and would have to check with the new hospital policy because only 2 years ago they start letting lvn's hang blood/blood products if iv certified and they didn't do this for a long time. I haven't yet got there answer back about k-riders. I also wanted to know what other states protocol was, these are the reasons I wanted to know where the answers were coming from. I appreciate all of the interesting responses I am getting.

[waves]

in cali- iv cert means blood and saline but no K. the rationale is that the K requires the RN training to recognize issues...due to cardiac, ie. possible death, effects.

[Brita01]

In California LVNs can't hang ANY type of piggyback. When I came to Lousiana, the LPNs do hang piggybacks and I felt so stupid because I didn't even know how to mix the vial of powder in with the little bag of fluid. :imbar It amazes me how the practice act in states can differ so much.

[UM Review RN, ASN, RN]

Quote

They are only allowed to push saline and hep lock solution. If a patient need IV Lasix, it has to be put in a 25 or 50 cc bag and given that way by an LPN.

Gee, in our hospital LPNs with the proper certification can push meds. As an RN, however, she's doing so under my license & supervision. The rest of your post is the same for us--RN does the assessments, must sign off on blood/blood products.

PS I'm in Central Florida

[pickledpepperRN]

LVN Scope of Practice:

In California LVNs may not administer medications intravenously.

Here are links:

https://www.bvnpt.ca.gov/pdf/vnregs.pdf

According to the Board of Registered Nursing (BRN), the Board has received multiple inquires from nursing organizations and individual nurses about the legal scope of practice for an RN who may be asked to: delegate to the LVN patient assessment for the purpose of determining a treatment; delegate to the LVN intravenous medication administration as the treatment; and direct the LVN to administer intravenous medication through a central line. According to the BRN, these questions have arisen in part due to practices at free standing dialysis clinics. The California Nurses Association (CNA) has also been extremely concerned about these same issues, as health care agencies have continued to downsize, restructure, deskill and redesign workload. This Nursing Practice Alert clarifies the legal scope of practice of RNs and LVNs as it pertains to the administration of intravenous medication in all settings.

LVN Scope of Practice and the Administration of IV Medications/Solutions

The Business and Profession Code, Section 2860.5 and California Code of Regulations, Article 8, Section 2542, are sections of the law that define LVN scope of practice in relationship to IVs. These sections state that an LVN who is IV certified, may start peripheral IVs and superimpose intravenous solutions of electrolytes, nutrients, vitamins, blood and blood products. The registered nurse is authorized to assign and supervise these activities and functions. LVNs do not have statutory authority to administer IV medications. In addition, an LVN does not have statutory authority to administer any intravenous agent via a central line. This applies to all practice settings.

RN Role and Responsibility

The Business and Professions Code, Section 2725, The Nursing Practice Act, authorizes registered nurses to assess patients, determine abnormalities, implement a medical treatment plan, refer, report, or implement a standardized procedure, and administer medication by all routes. The California Code of Regulations 1443.5 (4) states that the RN delegates tasks to subordinates based on the legal scope of practice of the subordinates and on the preparation and capability needed in the tasks to be delegated, and effectively supervises nursing care being given by subordinates.

It is the BRN's interpretation of the Nursing Practice Act that the RN function of assessment to determine abnormality, determine the appropriate treatment, and implement a treatment for the abnormality such as administration of an intravenous medication for a hemodialysis patient cannot be delegated by the RN to the LVN.

In other words, since LVNs do not have statutory authority to administer IV medications through either peripheral or central lines, this skill must not be delegated/assigned to them.

Furthermore, since LVNs do not have statutory authority to superimpose any agent through a central line, this skill must not be delegated/assigned to them. The RN can never delegate/assign these skills to the LVN or supervise the LVN performing these skills. For an RN to make such a delegation/assignment or supervise the LVN in these tasks would be a violation of the California Nursing Practice Act.

In conclusion, the RN is not authorized to delegate/assign to the LVN the administration of IV medication through a peripheral or central line. The RN is also not authorized to delegate/assign to the LVN the administration of any agent into a central line. Furthermore, the RN cannot supervise the performance of any of these tasks by the LVN.