Can you Initiate and Maintain IV's in Your State?

[FocusRN]

i was just checking the lpn scope of pracstice for louisiana, and i just noticed that lpn's can start and maintain iv's. i now in many places this is not the case. so how is it in your state?

i'll just post what they have on their site:

scope of practice

the practice of practical nursing is defined in section 961 of chapter 11, louisiana revised statutes of 1950. according to this law, practical nursing is the performance, for pay, of acts in the care, treatment or observation of the ill and for the maintenance of the health of others and the promotion of health care. practical nurses may train and/or supervise other nurses, and subordinate personnel. they may also instruct patients.

a licensed practical nurse must practice under the direction of one of the following: licensed physician, optometrist, dentist, psychologist, or registered nurse. a licensed practical nurse may perform duties consistent with his/her educational preparation. the licensed practical nurse may also, with appropriate training (which is approved by this board, and documented), perform additional specified acts which are authorized by the board of practical nurse examiners when directed to do so by the licensed physician, optometrist, dentist, psychologist, or registered nurse.

the louisiana state board of practical nurse examiners (lsbpne) has no "laundry list" of tasks/skills an lpn can perform. such lists tend to limit practice. scope of practice is a fluid concept. it changes as knowledge and technology expand. lpns must possess the knowledge, skill, and ability to perform their duties, therefore, scope of practice comes down to the competency of the individual lpn.

following are some of the tasks (those most frequently inquired about) an lpn may perform when the above conditions are met (note: this list is not inclusive of all of lpn practice and should not be used to define or limit practice):

initiate and maintain iv therapy and administer iv medications by ivpb and/or ivp (including hyperalimentation, blood and blood products)


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• reinsertion of suprapubic catheters
  

  
  

• accept verbal/phone orders directly from the prescriber (an optometrist, advanced practice registered nurse, physician, dentist, or psychologist)
  

  
  

• perform heparinization during hemodialysis
  

  
  

• serve as first surgical assistant (but may not suture, dissect or cauterize)
  

  
  

• maintain and administer meds via heparin locks
  

  
  

• pap smears/gc cultures/iud string checks/fundal heart tones/leopolds maneuvers
  

  
  

• apply unna boots
  

  
  

• load/monitor pca machines
  

  
  

• care for clients with external venous catheters (including hickman, groshong, brovia) and specifically: obtain blood specimens/connect and monitor iv fluids/connect ivpb, provide site care (including dressing changes)
  

  
  

• care for clients with internal venous access devices (including port-a-cath, life port) and specifically: access with and/or remove huber needle/draw blood/connect and monitor iv fluids and provide site care (including dressing changes)
  

  
  

• insert a feeding tube in a neonate
  

  
  

• reinsert a tracheostomy tube in an established tract
  

  
  

• remove sheaths in a cardiac cath lab and later d/c these lines
  

  
  

• perform tasks which promote pulmonary health and hygiene (administer oxygen, aerosol and ippb treatments, suction, perform cpt, etc.). lpns may not hold themselves out as respiratory therapists or respiratory therapy technicians.
  

  
  

• perform "head to toe" physical assessments
  

  
  

please call or write the board if you require further clarification.

[Marie_LPN, RN, LPN, RN]

We can start and maintain. (Virginia)

[ldynwht]

We can start and maintain (colorado)

[eborgelt]

I can start and maintain in Michigan, but cannot start or maintain in Ohio.

[txspadequeenRN, BSN, RN]

We can start, monitor and push most IV meds in Texas.........

[Tweety, BSN, RN]

Florida too.

[DutchgirlRN, ASN, RN]

Our LPN's can start, maintain and push IV meds. Their only restriction is they cannot push any med into a central line or PICC line. (Tennessee)

[luvdancink]

In PA we can start, we can hang fluids and pb, not tpn, blood, and cannot push.

~Kristy

[adidas99]

In IL, we can't hang IV's with more than 40 meq of KCL, IV pushes(other than flushes), TPN, blood, or anything thru a central line, PICC or port, no heparin drips. There's a few other things we can't do, but none of it's pertinent to my floor really.

[Imma_Nurse]

I can start and maintain in Michigan, but cannot start or maintain in Ohio.

Actually, yes you can start IV's in Ohio (granted you have taken the required 40 hour class set by the state). I was given the class less then 2 months after graduation from LPN school, I started plenty of IV's in an acute setting and in the nursing home, both in Ohio.

Here is a list of laws for Ohio...

ALLOWABLE PROCEDURES

1. Prepare an adult for IV therapy and select the peripheral intravenous site in the hand, forearm and/or antecubital fossa

area only. (Adult means anyone who has reached the age of majority, eighteen.)

2. Assemble and maintain equipment for:

a. Gravity drip infusion

b. Electronic controlling devices, excluding patient controlled devises

3. Perform venipuncture with a needle or catheter into a peripheral vein of the hand, foreann and/or antecubital fossa area.

4. Initiate (i.e. start or begin) the infusion of authorized IV solutions as directed by a licensed physician, dentist, optometrist or podiatrist, using only the vein of the hand,forearm, antecubital fossa and calculate infusion rate using standard formulas.

Authorized solutions are IV infusions containing one or a combination of the

following:

a. Dextrose 5%

b. Normal Saline

c. Lactated Ringers

d. Sodium Chloride .45%

e. Sodium Chloride 0.2%

f. Sterile water

(**For example, the LPN could start D5/Water or D51LR. Note: "Water" must always be sterile and used in

conjunction with other fluids.)

5. Maintain an infusion of the authorized solutions, listed in #4 above, that are being administered through a pre-existing

central venous or peripherally inserted central venous catheter (PICC) (Note: Maintain means to administer or

regulate IV infusions according to the prescribed flow rate.)

6. Verify the type of peripheral solution being administered.

7. Regulate a peripheral IV infusion according to the prescribed flow rate.

8. Perform routine IV administration set changes on a peripheral IV line.

9. Perform routine dressing changes at the insertion site of a peripheral venous or arterial infusion, peripherally inserted

central venous catheter or central venous pressure subclavian infusion.

10. Initiate, convert and flush peripheral intermittent infusion devices/heparin locks. The peripheral intermittent infusion

devices may be flushed with normal saline and/or heparin to maintain peripheral venous patency of an intermittent infusion device when the heparin does not alter and individual's clotting time and is a nontherapeutic strength. The flushing technique includes, but is not limited to, bolus or push.

11. Prepare or reconstitute an antibiotic additive only.

12. Initiate or maintain an intermittent IV infusion (piggyback) containing only an antibiotic additive. (No other additive may be administered via piggyback; the IV line being used must terminate in a peripheral vein.)

13. Discontinue a peripheral IV device.

14. Examine a peripheral infusion site. (Implied is reporting and recording significant observations.)

15. Hang subsequent containers of specified solutions (dextrose, 5%; normal saline; lactated ringers; sodium chloride .45%; sodium chloride .2%; or sterile water) that contain vitamins or electrolytes if a registered nurse initiated the same infusion.

Now Kentucky laws are alittle different, I know they changed the LPN's scope of practice in reguards to IV therapy. I know we are going to be allowed to do alot more IV pushes and stuff like that. I am just waiting for the "special" classes to be able to do that. I hate bothering down an RN to push decadron on my patients...

[mhull]

I'm in NC. We can start, maintain, d/c....do it all. We can also IV push. We don't have to take an IV class either.

[TBLPN, LPN]

In Indiana we can start and maintain IV's. I work in LTC and have started many IV's, some IV pushes, we hang TPN and handle PICC and midlines.