PA BON expands LPN practice regarding IV Therapy

Published Oct 23, 2012

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Effective 8/25/12, law expands role of LPN in IV Therapy to include PCA devices, permit administration of TPN and monitoring/discontinuing blood products.

IV therapy functions for licensed practical nurses

TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS

PART I. DEPARTMENT OF STATE

Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS

CHAPTER 21. STATE BOARD OF NURSING

Subchapter B. PRACTICAL NURSES

GENERAL PROVISIONS
21.145. Functions of the LPN.
(1) An LPN may initiate and maintain IV therapy only under the direction and supervision of a licensed professional nurse or health care provider authorized to issue orders for medical therapeutic or corrective measures (such as a CRNP, physician, physician assistant, podiatrist or dentist).
(2) Prior to the initiation of IV therapy, an LPN shall:
(i) Verify the order and identity of the patient.
(ii) Identify allergies, fluid and medication compatibilities.
(iii) Monitor the patient's circulatory system and infusion site.
(iv) Inspect all equipment.
(v) Instruct the patient regarding the risk and complication of therapy.
(3) Maintenance of IV therapy by an LPN shall include ongoing observation and focused assessment of the patient, monitoring the IV site and maintaining the equipment.
(4) For a patient whose condition is determined by the LPN's supervisor to be stable and predictable, and rapid change is not anticipated, the supervisor may supervise the LPN's provision of IV therapy by physical presence or electronic communication. If supervision is provided by electronic communication, the LPN shall have access to assistance readily available.
(5) In the following cases, an LPN may provide IV therapy only when the LPN's supervisor is physically present in the immediate vicinity of the LPN and immediately available to intervene in the care of the patient:
(i) When a patient's condition is critical, fluctuating, unstable or unpredictable.
(ii) When a patient has developed signs and symptoms of an IV catheter-related infection, venous thrombosis or central line catheter occlusion.
(iii) When a patient is receiving hemodialysis.
(g) An LPN who has met the education and training requirements of 21.145b (relating to IV therapy curriculum requirements) may perform the following IV therapy functions, except as limited under 21.145a and only under supervision as required under subsection (f):
(1) Adjustment of the flow rate on IV infusions.
(2) Observation and reporting of subjective and objective signs of adverse reactions to any IV administration and initiation of appropriate interventions.
(3) Administration of IV fluids and medications.
(4) Observation of the IV insertion site and performance of insertion site care.
(5) Performance of maintenance. Maintenance includes dressing changes, IV tubing changes, and saline or heparin flushes.
(6) Discontinuance of a medication or fluid infusion, including infusion devices.
(7) Conversion of a continuous infusion to an intermittent infusion.
(8) Insertion or removal of a peripheral short catheter.
(9) Maintenance, monitoring and discontinuance of blood, blood components and plasma volume expanders.
(10) Administration of solutions to maintain patency of an IV access device via direct push or bolus route.
(11) Maintenance and discontinuance of IV medications and fluids given via a patient-controlled administration system.
(12) Administration, maintenance and discontinuance of parenteral nutrition and fat emulsion solutions.
(13) Collection of blood specimens from an IV access device.
[h=3] 21.145a. Prohibited acts.[/h] An LPN may not perform the following IV therapy functions:
(1) Initiate administration of blood, blood components and plasma volume expanders.
(2) Administer tissue plasminogen activators, immunoglobulins, antineoplastic agents or investigational drugs.
(3) Access a central venous route access device used for hemodynamic monitoring.
(4) Administer medications or fluids via arterial lines.
(5) Administer medications via push or bolus route.
(6) Administer fibrinolytic or thrombolytic agents to declot any IV access device.
(7) Administer medications requiring titration.
(8) Insert or remove any IV access device, except a peripheral short catheter.
(9) Access or program an implanted IV infusion pump.
(10) Administer IV medications for the purpose of procedural sedation or anesthesia.
(11) Administer fluids or medications via an epidural, intrathecal, intraosseous or umbilical route, or via a ventricular reservoir.
(12) Administer medications or fluids via an arteriovenous fistula or graft, except for dialysis.
(13) Perform repair of a central venous route access device or PICC.
(14) Perform therapeutic phlebotomy.
(15) Direct access of implantable devices.