Kentucky Board of Nursing Practice Corner

Kentucky Board of Nursing Practice Corner

Sutherland, Bernadette

Kentucky Board of Nursing Adopts Administrative Regulation on LPN Intravenous Therapy Practice

In June, the Kentucky Board of Nursing approved a proposed Kentucky Administrative Regulation, 201 KAR 20:490, governing licensed practical nurse intravenous (IV) therapy scope of practice. The regulation has undergone the statutory review process by state legislative committees and now is in effect as of September 15, 2004.

Following more than a yearlong study of the role and utilization of licensed practical nurses, the Board received and approved recommendations to expand the scope of licensed practical nursing practice in the area of intravenous therapy practice. Since 1983, the Board has published an Advisory Opinion Statement entitled “Roles of Nurses in IV Therapy Practice” as a guideline to nurses. The advisory statement did not carry the force and effect of law; however, the administrative regulation does.

The regulation contains definitions of terms; education and training standards; supervision requirements; standards of practice; and permitted and prohibited functions. In addition, the regulation identifies IV therapy functions that are recognized as being within the current scope of licensed practical nursing practice, as well as identifies functions that will be an expansion ofthat practice. An LPN who has met the education and training requirements may perform select functions except as limited and under supervision as stated in the regulation.

The regulation requires that the education and training of LPNs . who perform IV therapy contain specific components and be based upon the Policies and Procedures for Infusion Nursing, second Edition (2002), published by the Infusion Nurses Society (INS). This document, along with the Infusion Nursing Standards of Practice, may be obtained from INS, 220 Norwood Park South, Norwood, MA 02062. Standards of Practice, may be obtained from INS, 220 Norwood Park South, Norwood, MA 02062. Telephone: 781-440-9408. Website: www.inisl.org.

If you have any questions about the newly adopted regulation, please contact Bernadette Sutherland, Nursing Practice Consultant, at the Kentucky Board of Nursing office in Louisville at 502-329-7007 or 1-800-305-2042, Ext. 231.

A copy of 201 KAR 20:490, Licensed Practical Nurse Intravenous Therapy Scope of Practice, is printed in its entirety below:

201 KAR 20:490. Licensed practical nurse intravenous therapy scope of practice.

RELATESTO: KRS 314.01 1(10)(a), (c)

STATUTORY AUTHORITY: KRS 314.031(1), 314.011(10)(c)

NECESSITY, FUNCTION, AND CONFORMITY: KRS 314.011(10(c) authorizes the board to promulgate an administration regulation to establish the scope of practice for administering medicine or treatment by a licensed practical nurse and KRS 314.01 l(10)(a) requires that licensed practical nurses practice under the direction of a registered nurse, physician, or dentist. This administrative regulation establishes the scope of that practice as it relates to intravenous therapy.

Section 1. Definitions.

(1) “Antineoplastic agent” means a medication that prevents the development, growth, or proliferation of malignant cells.

(2) “Bolus” means a concentrated medication or solution given over a period of time.

(3) “Central venous route access device” means a catheter that is inserted in such a manner that the distal tip is located in the superior vena cava, including a peripherally-inserted central catheter.

(4) “Direction” means a communication of a plan of care that is based upon assessment of a patient by an advanced registered nurse practitioner, a registered nurse, physician, or dentist that establishes the parameters for the provision of care or for the performance of a procedure.

(5) “Discontinuance” means to stop the infusion of the medication or fluid and does not include removal of the intravenous access device.

(6) “Mix” means to combine two (2) or more medications or solutions, and does not mean to reconstitute a powder into a liquid, or to dilute a medication or solution to decrease its strength.

(7) “Peripheral route access device” means a peripherally-inserted intravenous access device that is less than or equal to three (3) inches in length.

(8) “Pharmacology” means information on the classification of intravenous drugs, indications for use, pharmacological properties, monitoring parameters, contraindications, dosing, clinical mathematics, anticipated side effects, potential complications, antidotal therapy, compatibilities, stabilities, specific considerations for select intravenous drugs, and administration of intravenous medications to pediatric, adult, and geriatric populations.

(9) “Procedural sedation” means the administration of intravenous medications to produce a state that allows a patient to tolerate unpleasant procedures and results in a depressed level of consciousness.

(10) “Push” means manual administration of medication under pressure.

(11) “Supervision” means the provision of guidance by a registered nurse, advanced registered nurse practitioner, physician or dentist for the accomplishment of a nursing task with periodic observation and evaluation of the performance of the task including validation that the nursing task has been performed in a safe manner.

(12) “Supervisor” means the registered nurse, advanced registered nurse practitioner, physician or dentist who provides supervision of the licensed practical nurse’s practice as defined in subsection (11) of this section.

(13) “Therapeutic phlebotomy” means a clinical procedure whereby blood volume is reduced to achieve a therapeutic hematocrit level.

(14) “Thrombolytic agent” means a pharamacological agent capable of dissolving blood clots.

(15) “Titration” means adjustment of a medication dosage or rate of solution infusion within a therapeutic range that is based, on the assessment of a patient.

Section 2. Education and Training Standards.

(1) Prior to performing intravenous (IV) therapy, the licensed practical nurse (LPN) shall have completed education and training related to the scope of IV therapy for an LPN. This education and training shall be obtained through:

(a) A prelicensure program of nursing for individuals admitted to the program after the effective date of this administrative regulation; or

(b) An institution, practice setting, or continuing education provider that has in place a written instructional program and a competency validation mechanism that includes a process for evaluation and documentation of an LPNs demonstration of the knowledge, skills, and abilities related to the safe administration of IV therapy. The LPN shall receive and maintain written documentation of completion of the instructional program and competency validation.

(2) The education and training programs recognized in subsection (1) of this section shall be based on “Policies and Procedures for Infusion Nursing” and shall include the following components:

(a) Technology and clinical applications;

(b) Fluid and electrolyte balance;

(c) Pharmacology;

(d) Infection control;

(e) Transfusion therapy;

(f) Parenteral nutrition; and

(g) Legal aspects based on ICRS Chapter 314 and this administrative regulation.

Section 3. Supervision Requirements.

(1) An LPN performing IV therapy procedures shall be under the direction and supervision of a registered nurse (RN), advanced registered nurse practitioner (ARNP), physician, or dentist.

(2) For a patient whose condition is determined by the LPNs supervisor to be stable and predictable, and rapid change is not anticipated, the supervisor may provide supervision of the LPNs provision of IV therapy without being physically present in the immediate vicinity of the LPN, but shall be readily available.

(3) In the following cases, for the LPN to provide IV therapy, the LPNs supervisor shall be physically present in the immediate vicinity of the LPN and immediately available to intervene in the care of the patient:

(a) If a patient’s condition is or becomes critical, fluctuating, unstable, or unpredictable;

(b) If IV medications or fluids are administered by push or bolus administration, except for saline or heparin to maintain patency of an IV access device;

(c) If a patient has developed signs and symptoms of an IV catheter-related infection, venous thrombosis, or central line catheter occlusion;

(d) If a patient is receiving blood, blood components, or plasma volume expanders; or

(e) If a patient is receiving peritoneal dialysis or hemodialysis.

Section 4. Standards of Practice.

(1) An LPN shall perform only those IV therapy acts for which the LPN possesses the knowledge, skill, and ability to perform in a safe manner, except as limited by section 6 of this administrative regulation and under supervision as required by section 3 of this administrative regulation.

(2) An LPN shall consult with an RN or other appropriate individual and seek guidance as needed if:

(a) The patient’s care needs exceed the licensed practical nursing scope of practice;

(b) The patient’s care needs surpass the LPNs knowledge, skill, or ability; or

(c) The patient’s condition becomes unstable or imminent assistance is needed.

(3) An LPN shall obtain instruction and supervision as necessary if implementing new or unfamiliar nursing practices or procedures.

(4) An LPN shall follow the written, established policies and procedures of the facility that are consistent with KRS Chapter 314.

Section 5. Functions That May Be Performed. An LPN who has met the education and training requirements of section 2 of this administrative regulation may perform the following IV therapy functions, except as limited by section 6 of this administrative regulation and under supervision as required by section 3 of this administrative regulation:

(1) Calculation and adjustment of the flow rate on all IV infusions;

(2) Observation and reporting of subjective and objective signs of adverse reactions to any IV administration and initiate appropriate interventions;

(3) For all IV access devices:

(a) Administration of IV fluids and medications;

(b) Performance of site care;

(c) Performance of maintenance;

(d) Discontinuance of a medication or fluid infusion; and

(e) Conversion of a continuous infusion to an intermittent infusion.

(4) Insertion or removal of a peripheral route access device;

(5) Administration, maintenance, and discontinuance of blood, blood components, and plasma volume expanders;

(6) Administration of IV medications and fluids that are mixed and labeled by an RN, AFiNP, physician, dentist, or pharmacist or are commercially prepared;

(7) Administration of antiemetics, the antagonistic agents for analgesics and antiemetics, diuretics, corticosteroids, and saline or heparin to maintain patency of an IV access device via direct push or bolus route;

(8) Administration of glucose to patients fourteen (14) years of age or older via direct push or bolus route;

(9) Administration, maintenance, and discontinuance of IV medications and fluids given via a patient controlled administration system;

(10) Administration, maintenance, and discontinuance of parenteral nutrition and fat emulsion solutions;

(11) Performance of dialysis treatment; and

(12) Collection of blood specimens from an IV access device.

Section 6. Functions that Shall Not be Performed. An LPN shall not perform the following IV therapy functions:

(1) Administration of tissue plasminogen activators, immunoglobulins, antineoplastic agents, or investigational drugs;

(2) Accessing of a central venous route access device used for hemodynamic monitoring;

(3) Administration of medications or fluids via arterial lines;

(4) Administration of medications via push or bolus route except as permitted by section 5(7) or (8) of this administrative regulation.

(5) Administration of a fibrinolytic or thrombolytic agent to declot any IV access device;

(6) Administration of medications requiring titration;

(7) Insertion or removal of any IV access device, except a peripheral route access device;

(8) Accessing or programming an implanted IV infusion pump,

(9) Administration of IV medications for the purpose of procedural sedation or anesthesia;

(10) Administration of fluids or medications via an epidural, intrathecal, intraosseous, or umbilical route, or via a ventricular reservoir;

(11) Administration of medications or fluids via an arteriovenous fistula or graft, except for dialysis;

(12) Performance of the repair of a central venous route access device; or

(13) Performance of therapeutic phlebotomy.

Section 7. Incorporation by Reference.

(1) “Policies and Procedures for Infusion Nursing,” second Edition (2002), Infusion Nurses Society, is incorporated by reference.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky, Monday through Friday, 8 a.m. to 4:30 p.m. (30 Ky.R. 2585; Am. 31 Ky.R. 369; 546; eff. 9-15-04).

by Bernadette Sutherland, RN, MSN

Nursing Practice Consultant, KBN

Copyright Kentucky Nurses Association Oct-Dec 2004

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