State laws and regulations specific to dialysis: an overview
The renal community has long had need for a thorough compilation of information on laws and regulations specific to dialysis on a state by state basis to guide the clinical practice of dialysis and for compliance purposes. In recognition of that need, Fresenius Medical Care North America (FMCNA) undertook the process of gathering such information. The final product has been offered to the community through the American Nephrology Nurses’ Association since much of the information relates to the scope of practice and delegation authority of registered nurses and the licensed practical/vocational nurses and unlicensed dialysis technicians they supervise. FMCNA has made a commitment to update this information on a regular basis for publication annually. ANNA is grateful to Fresenius for this contribution to the industry.
Heparin and Delegation Authority of RNs/
State Saline Limitations on LPN/LVNs or UAP
ALABAMA NO Tasks that may not be delegated
to UAP include administration of
medications. Limits on IV
therapy by LPN–no direct IV
ALASKA NO Nursing tasks that shall not be
delegated from RNs to LPNs include
“Administer IV push medications
ARKANSAS NO Nursing tasks that shall not be
delegated … “Administration of
any medications or IV therapy,
including blood or blood products.”
ARIZONA YES Dialysis technician certification
through a national organization
(NANT) or have completion of
minimum training requirements.
summary/h.hb2359 2-08-02 health.doc.htm
Experienced hemodialysis technician trainees
may administer local anesthetic, anticoagu-
lants, or replacement saline.
CALIFORNIA YES Cannulation, administration of local
anesthetics, heparin, and sodium chloride
solutions allowed for technicians.
LPNs may not access central line catheters.
COLORADO No Express Broad delegation language.
CONNECTICUT NO Staffing requirements include 50% licensed
nurses. PCTs may initiate, monitor, and
terminate dialysis treatments.
DELAWARE NO Delegation by RNs only. RNs may not dele-
gate administration of meds to UAP.
DISTRICT of No Express Scope of Practice for LPNs includes adminis-
COLUMBIA Prohibition tering medication.
FLORIDA No Heparin No RN delegation language.
Yes Saline www.fisenate.gov/Statutes/index.cfm
Agency for Healthcare Administration
position statement prohibits heparin
GEORGIA No Heparin Requires training program for hemodialysis
Yes Saline PCTs. National certification exam not
required. LPNs required to meet the same
training and competency requirements as
HAWAII No Express No delegation of IV meds unless criteria for
Prohibition delegation is met.” Delegation criteria…
“the delegating RN shall teach UAP special
tasks of nursing care and verify the UAP’s
competency to perform the tasks.”
IDAHO NO May not delegate to UAPs preparation or
administration of injections, or start,
stop, or adjust any IV therapy.
ILLINOIS NO Delegation: The transfer of responsibility
for the performance of selected tasks by
the registered nurse (RN) to qualified,
competent assistive personnel in a
selected situation, based upon the
RN’s plan of care.
INDIANA No Express RNs can delegate if task does not exceed
Probibition the scope of practice of delegatee. Nurses
must balance with ethical duty where there
can be no delegation if the nurse
knows/should know it is detrimental to
IOWA No Express In a dialysis unit, RN may delegate heparin
Prohibition and saline administration to an LPN. RN
cannot delegate to UAP anything beyond the
scope of practice of LPN.
KANSAS YES All nursing procedures, including, but not
limited to, the administration of
medication, delegated by a licensed nurse
to a designated unlicensed person shall be
KENTUCKY YES Dialysis Tech Credentialing. PCTs may
cannulate, and administer heparin
(specified doses), normal saline,
LOUISIANA No IV Push Advisory Opinion allows LPN administration
of IV heparin for hemodialysis.
MAINE No Express Rules mention UAPs and CNAs. Nothing spe-
Prohibition cific on dialysis PCTs. Certified Nursing
Assistants may administer meds, but only
if a med course is taken, certain meds
only, and no IV meds.
MARYLAND YES Dialysis technicians are listed as a
specific category of certified nursing
assistant, CAN–DT Approved training
program is required; two year renewal
tie chapters/10 Chapters.htm#Subtitle27
MASSACHU- YES Delegation to Unlicensed Personnel. Nursing
SETTS advisory ruling.
Mass Nurses Organization Position
MICHIGAN No Express Broad delegation language.
MINNESOTA No Express In a nursing home setting, medications by
Prohibition injection can be given only by physician,
physician’s assistant, RN, LPN. Nothing on
536882405&agency=N u rsi ng Board
MISSISSIPPI NO Administration of meds can be delegated only
to licensed nurses, either an RN or LPN.
Nursing rules allow LPNs to cannulate and
administer IV heparin or IV saline.
Technicians may not cannulate.
MISSOURI No Express LPNs allowed to administer IV heparin. No
Prohibition specific language regarding delegating to
MONTANA No Express Nurses cannot delegate administration of
NEBRASKA YES Specific hemodialysis functions allowed for
LPNs and PCTs include cannulation and
administration of heparin and saline.
NEVADA YES A drug or medicine referred to in NRS
454.181 to 454.371, inclusive, may be
possessed and administered by: “A
dialysis technician, under the direction
or supervision of a physician or
registered nurse only if the drug or
medicine is used for the process of renal
NEW YES RNs only can delegate IV administration of
HAMPSHIRE meds. Delegation of a task of client care
involving the administration of medication
shall specify the med, dosage, route.
Pharmacy rules allow PCTs to administer
saline and heparin.
NEW JERSEY No Express An RN may delegate selected nursing tasks to
Prohibition the LPN and ancillary nursing personnel
(including aids, assistants, attendants and
technicians). Nothing specific as to
administration of medications or dialysis
NEW MEXICO YES Hemodialysis Technician can cannulate and
administer heparin bolus. Training and
testing required for certified
NEW YORK NO Properly trained dialysis technicians are
allowed to flush IV lines with pre-
determined doses of heparin when
Limitations on LPNs administering IV meds.
No IV push except saline or heparin.
NORTH NO The dialysis technician may administer
CAROLINA heparin, lidocaine, and normal saline.
Cannulation may be done by licensed nurse or
competent dialysis technician.
NORTH DAKOTA YES Delegation rules for UAPs do not allow
OHIO NO Delegation–Dialysis Technicians can
administer IV heparin. Tech rules
OKLAHOMA NO Administration of meds may not be delegated.
BONPosition Paper on LPN administration of
IV meds, May 2002 … “IV therapy and
medication administration may be within the
scope of practice of LPN who has appropriate
educational training and under supervision.”
OREGON YES Effective August 2001. Requires
certification by a nationally
PENNSYLVANIA YES [section] 18.402. Delegation A medical
doctor may delegate to a health care
practitioner or technician the
performance of a medical service if
certain conditions are met.
LPNs can administer IV meds after
completing an approved course.
RHODE ISLAND No Express Broad delgation language. State approved
broad Prohibition delegation course for
nursing students , no controlled substances
SOUTH NO After June 30, 1985, unlicensed nursing
CAROLINA personnel shall not administer medications.
BON–the reguations preclude the licensed
nurse from delegating administration of
medications to UAP
LPNs may administer IV saline /heparin push.
SOUTH DAKOTA YES LPNs may cannulate and administer IV saline
Dialysis techs may administer loading and
maintenance doses of heparin according to
TENNESSEE NO LNPs may administer IV meds in ESRD
settings–BON Position Statement.
BON will not approve a program for UAPs to
TEXAS YES Licensure law/regs allow cannulation,
administration of heparin, saline, and
lidocaine. Requires training for dialysis
technicians, certification by a
nationally standardized examination may be
UTAH No Express Broad delegation language from RN to UAP.
VERMONT No Express LPNs allowed to perform IV therapy. Nothing
Prohibition specific to dialysis technicians.
VIRGINIA YES PCTs may administer heparin, saline PCT
WASHINGTON YES July 2001–Dialysis regulations requires
standardized training of technicians.
LPNs may administer IV push if protocols
A health care assistant trained by a
federally-approved ESRD facility may
perform venipuncture for blood withdrawal,
venipuncture for placement of fistula
needles, IV administration of heparin and
saline as an integral part of dialysis
WEST VIRGINIA NO Additional limitations on medication
administration by facility staff members
include injections or parenteral
medications. No delegation authority
for techs to administer saline or heparin;
recent law passed, requires subsequent
WISCONSIN No Express LPNs may administer IV medications with
Prohibition supervision if competent.
Delegation language is very broad.
WYOMING No Express Broad delegation language. Regulations
Prohibition defining the role of certified nursing
No dialysis technician language.
Technician Dialysis Facility
State Legislation Legislation
ALABAMA NO CON
ARIZONA YES Licensure
CALIFORNIA YES Licensure
COLORADO NO Licensure
CONNECTICUT YES Licensure
DISTRICT of NO CON
HAWAII NO CON
IDAHO NO NO
ILLINOIS NO Licensure law
passed; no rules
MONTANA Dialysis technician
language in pro-
rules as of 1/05.
NEW JERSEY Licensure
NEW MEXICO YES Licensure
NEW YORK YES CON
NORTH YES CON
OHIO YES CON
RHODE ISLAND YES Licensure
SOUTH YES Licensure
SOUTH DAKOTA NO
WEST VIRGINIA CON
Acknowledgement: The author would like to thank Kasia Januszewski Bartos, Esq., and Mary B. Snyder, MA, JD, Regulatory Affairs Manager, both of Fresenius Medical Care North America, for conducting much of the initial state-by-state research on which this final document is based.
Disclaimer: The information contained in the document is limited to the information published on Board of Nursing (BoN) websites, BoN advisory opinions, and the accessibility of other communications; rules and regulations. It is intended as a general reference tool to facilitate state-specific research, is current only through December 2004, does not constitute legal advice, and should not be used as a substitute for review of the actual statutes and regulations governing scope of practice in any jurisdiction.
Cathleen O’Keefe, JD, RN, is Executive Director, Regulatory, Government Affairs, and Compliance, Spectra, Laboratory Division of Fresenius at Fresenius Medical Care North America, Lexington, MA.
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