State laws and regulations specific to dialysis: an overview
Cathleen O’Keefe
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.
PCTs
Allowed to
Administer
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
bolus meds.
www.abn.state.al.us/welcome.html
ALASKA NO Nursing tasks that shall not be
delegated from RNs to LPNs include
“Administer IV push medications
–RNs Only.”
www.dced.state.ak.us/occ/pub/Nursing
Statutes.pdf
ARKANSAS NO Nursing tasks that shall not be
delegated … “Administration of
any medications or IV therapy,
including blood or blood products.”
http://www.arsbn.org/
ARIZONA YES Dialysis technician certification
through a national organization
(NANT) or have completion of
minimum training requirements.
www.azleg.state.az.us/legtext/45leg/2r/
summary/h.hb2359 2-08-02 health.doc.htm
Experienced hemodialysis technician trainees
may administer local anesthetic, anticoagu-
lants, or replacement saline.
www.azsos.gov/public_services/Title_09/
9-10.rtf.
CALIFORNIA YES Cannulation, administration of local
anesthetics, heparin, and sodium chloride
solutions allowed for technicians.
Certification required.
www.caselaw.1p.findlaw.com/cacodes/bpc/
1247%2D1247.9.html
LPNs may not access central line catheters.
http://www.bvnpt.ca.gov/pdf/vnregs.pdf
COLORADO No Express Broad delegation language.
Prohibition http://www.dora.state.co.us/nursing/
statutesandrules/npa.htm
CONNECTICUT NO Staffing requirements include 50% licensed
nurses. PCTs may initiate, monitor, and
terminate dialysis treatments.
www.dph.state.ct.us/phc.doc
DELAWARE NO Delegation by RNs only. RNs may not dele-
gate administration of meds to UAP.
www.professionallicensing.state.de.us/
boards/nursing/renewal.shtml
DISTRICT of No Express Scope of Practice for LPNs includes adminis-
COLUMBIA Prohibition tering medication.
www.dchealth.dc.gov/prof license/services/
pdffile/PDF_frameset.asp?id=Nursing/Munici
palNursingRegulations.pdf&strAppld=11
FLORIDA No Heparin No RN delegation language.
Yes Saline www.fisenate.gov/Statutes/index.cfm
Agency for Healthcare Administration
position statement prohibits heparin
administration.
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
PCTs.
http://www2.state.ga. us/Departments/DHR/
ORS/esrdrules.htm#290-9-9-.11
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.”
www. hawaii.gov/dcca/pdf/hrs_pvl_457.pdf
IDAHO NO May not delegate to UAPs preparation or
administration of injections, or start,
stop, or adjust any IV therapy.
http://www2.state.id.us/adm/adminruies/rul
es/idapa23/0101.pdf
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.
www.ildpr.com/WHO/nurs.asp
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
patient’s health.
www.state.in.us/hpb/boards/isbn/nursing_
compilation.pdf
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.
www.legis.state.ia.us/Rules/2003/lac/655/65
56/6556.pdf
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
supervised.
www.ksbn.org/npatoc.htm
KENTUCKY YES Dialysis Tech Credentialing. PCTs may
cannulate, and administer heparin
(specified doses), normal saline,
intradermal lidocaine.
www.kbn.ky.gov/practice.htm
LOUISIANA No IV Push Advisory Opinion allows LPN administration
of IV heparin for hemodialysis.
http://www.isbpne.com/practice_opinions.htm
http://www.isbn.state.1a.us/Documents/sco
pe/rnscope.pdf
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.
http://janus.state.me.us/legis/statutes/32/
title32ch31sec0.html
MARYLAND YES Dialysis technicians are listed as a
specific category of certified nursing
assistant, CAN–DT Approved training
program is required; two year renewal
period.
http://www.dsd.state.md.us/comar/subti-
tie chapters/10 Chapters.htm#Subtitle27
MASSACHU- YES Delegation to Unlicensed Personnel. Nursing
SETTS advisory ruling.
www.mass.gov/dpVboardstrn/cmr/24403.htm#3.05
Mass Nurses Organization Position
Statement.
http://www.massone.org/main/Position%20
Statements/Unlicensed%20Assistive%20Per
sonnel.htm
MICHIGAN No Express Broad delegation language.
Prohibition http://www.state.ml.us/orr/emi/admincode.a
sp?AdmiinCode=Single&Admin Num=3381
0101& Dpt=CH&RngHigh=
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
dialysis.
http://www.state.mn.us/cgibin/portal/mn/jsp
/content.do?rc layout=bottom&subchan-
nel=null&programid=536898085&sc3=null&
sc2=null&id=-
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.
http://www.msbn.state.ms.us/pdf/
RulesRegs.pdf
MISSOURI No Express LPNs allowed to administer IV heparin. No
Prohibition specific language regarding delegating to
dialysis technicians.
http://www.sos.mo.gov/adruies/csr/cur-
rent/4csr/4c200-6.pdf
MONTANA No Express Nurses cannot delegate administration of
Prohibition medications.
http://www.discoveringmontana.com/dil/bs
d/license/bsd_boards/nur_board/pdf/prac-
tice_statements.pdf
NEBRASKA YES Specific hemodialysis functions allowed for
LPNs and PCTs include cannulation and
administration of heparin and saline.
http://www.hhs.state.ne.us/crl/nursing/rn%
2DIpn/advisory.htm#DELEGATION
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
dialysis.”
http://www.leg.state.nv.us/NRS/NRS-454.html
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.
http://gencourt.state.nh.us/rules/nur100-
900.html#nur400
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
technicians.
http://www.state.nj.us/lps/ca/nursing/nursel
aws.pdf
NEW MEXICO YES Hemodialysis Technician can cannulate and
administer heparin bolus. Training and
testing required for certified
hemodialysis technicians.
http://www.state.nm.us/clients/nursing/pdf/
nmacpart4.pdf
NEW YORK NO Properly trained dialysis technicians are
allowed to flush IV lines with pre-
determined doses of heparin when
initiating dialysis.
http://www.nysna.org/programs/practice/ale
its/alert5.htm
Limitations on LPNs administering IV meds.
No IV push except saline or heparin.
http://www.op.nysed.gov/nurse-lpn-iv-
longterm.htm
NORTH NO The dialysis technician may administer
CAROLINA heparin, lidocaine, and normal saline.
Cannulation may be done by licensed nurse or
competent dialysis technician.
http://www.ncbon.com/prac-hemo.asp
NORTH DAKOTA YES Delegation rules for UAPs do not allow
IV meds.
http://www.ndbon.org/unlicensed/
medication_admin.html
OHIO NO Delegation–Dialysis Technicians can
administer IV heparin. Tech rules
require certification.
http://www.nursing.ohio.gov/pdfs/NewLaw
Rules/CHAPT 23.pdf
OKLAHOMA NO Administration of meds may not be delegated.
www.youroklahoma.com/nursing/delegation.pdf
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.”
http://www.youroklahoma.com/nursing/
prac1.html
OREGON YES Effective August 2001. Requires
certification by a nationally
standardized exam
http://www.sos.state.or.ustarchivestruies/
OARs_300/OAR_333/333_275.html
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.
www.pacode.conVsecure/data/049/chapter18/
subchapGtoc.html
LPNs can administer IV meds after
completing an approved course.
www.dos.state.pa.ustbpoa/lib/bpoa/20/
nurs_board/nurseact.pdf
RHODE ISLAND No Express Broad delgation language. State approved
broad Prohibition delegation course for
nursing students , no controlled substances
allowed.
http://www.health.ri.gov/hsr/regulations/
proposed/nursing_prop.pdf
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
http://www.llr.state.sc.us/pol/nursing/
index.asp?file=uaptasks.htm
LPNs may administer IV saline /heparin push.
www.llr.state.sc.us/poVnursingrndex.asp?
file=advisoryop10b.htm
SOUTH DAKOTA YES LPNs may cannulate and administer IV saline
and heparin.
http:/Aegis.state.sd.ustruiestrules/2048.
htm#20:48:04.01:12
Dialysis techs may administer loading and
maintenance doses of heparin according to
prescribed protocol.
http:/Aegis.state.sd.ustruiestruies/2048.
htm#20:48:04.02:05
TENNESSEE NO LNPs may administer IV meds in ESRD
settings–BON Position Statement.
http://www2.state.tn.usthealth/Downloads/
g4014009.pdf
BON will not approve a program for UAPs to
administer meds.12/01
http://www2.state.tn.usthealth/Downloadstg
4021186.pdf
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
substituted.
http://www.tdh.state.tx.us/hfc/esrd%5F117.pdf
UTAH No Express Broad delegation language from RN to UAP.
Prohibition http://www.dopl.utah.gov/licensing/
statutes_and_rules/13156-31b.PDF
VERMONT No Express LPNs allowed to perform IV therapy. Nothing
Prohibition specific to dialysis technicians.
http://vtprofessionals.org/oprl/nurses/
forms/nursingopinions.pdf
VIRGINIA YES PCTs may administer heparin, saline PCT
training program.
www.dhp.state.va.us/bhpfeg/Dialysis%20
regs.doc
WASHINGTON YES July 2001–Dialysis regulations requires
standardized training of technicians.
LPNs may administer IV push if protocols
in place
https://wws2.wa.gov/doh/hpga-licensing/
HPS6/Nursing/documents/LPN-ivtherapypdf
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
treatment
www.leg.wa.gov/si/2001-02/1309_sltxt
www.leg.wa.gov/RCW/index.cfm?se-
tion=18.135.060&fuseaction=section
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
legislation.
http://www.wvrnboard.com/scope.pdf
WISCONSIN No Express LPNs may administer IV medications with
Prohibition supervision if competent.
http://dri.wi.gov/dept/papers/pap04.pdf
Delegation language is very broad.
http://drl.wi.gov/dept/papers/pap05.pdf
WYOMING No Express Broad delegation language. Regulations
Prohibition defining the role of certified nursing
assistants.
No dialysis technician language.
http://nursing.state.wy.us/
Dialysis
Technician Dialysis Facility
State Legislation Legislation
ALABAMA NO CON
and Licensure
ALASKA NO
ARKANSAS NO
ARIZONA YES Licensure
Included with
facility licensure
law
CALIFORNIA YES Licensure
COLORADO NO Licensure
CONNECTICUT YES Licensure
DELAWARE NO
DISTRICT of NO CON
COLUMBIA
FLORIDA NO
GEORGIA Licensure
HAWAII NO CON
IDAHO NO NO
ILLINOIS NO Licensure law
passed; no rules
promulgated
INDIANA
IOWA
KANSAS
KENTUCKY Licensure
LOUISIANA Licensure
MAINE CON
Licensure
MARYLAND YES
MASSACHU- Licensure
SETTS
MICHIGAN
MINNESOTA
MISSISSIPPI CON
MISSOURI CON
MONTANA Dialysis technician
language in pro-
posed delegation
rules as of 1/05.
NEBRASKA YES
NEVADA Licensure
NEW Licensure
HAMPSHIRE
NEW JERSEY Licensure
NEW MEXICO YES Licensure
NEW YORK YES CON
Licensure
NORTH YES CON
CAROLINA
NORTH DAKOTA
OHIO YES CON
OKLAHOMA Proposed
Licensure Law
OREGON Licensure
PENNSYLVANIA
RHODE ISLAND YES Licensure
SOUTH YES Licensure
CAROLINA
SOUTH DAKOTA NO
TENNESSEE Licensure
TEXAS Licensure
UTAH
VERMONT
VIRGINIA
WASHINGTON CON
WEST VIRGINIA CON
WISCONSIN
WYOMING
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.
COPYRIGHT 2005 Jannetti Publications, Inc.
COPYRIGHT 2007 Gale Group
