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

Link to law: http://www.lrc.ky.gov/kar/201/020/490.htm
Published: 2015

      201 KAR 20:490. Licensed practical nurse intravenous therapy

scope of practice.

 

      RELATES TO: KRS 314.011(10)(a), (c)

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

314.131(1), 314.011(10)(c)

      NECESSITY, FUNCTION, AND CONFORMITY: KRS

314.131(1) authorizes the Board of Nursing to promulgate administrative

regulations as may be necessary to enable it to carry into effect the

provisions of KRS Chapter 314. KRS 314.011(10)(c) authorizes the board to

promulgate an administrative regulation to establish the scope of practice for

administering medicine or treatment by a licensed practical nurse. KRS

314.011(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)

"Administration" means to initiate and infuse intravenous therapy.

      (2) "Antineoplastic agent"

means a medication that prevents the development, growth, or proliferation of

malignant cells.

      (3) "Bolus" means a

concentrated medication or solution given rapidly over a short period of time.

      (4) "Central venous access

device" means a device that permits access to the central vascular system

and is inserted with the tip residing in the lower one-third of the superior

vena cava or above the level of the diaphragm in the inferior vena cava.

      (5) "Direction" means a

communication of a plan of care that is based upon assessment of a patient by

an advanced practice registered nurse, a registered nurse, physician, or dentist

that establishes the parameters for the provision of care or for the

performance of a procedure.

      (6) "Discontinuance" means to

stop the infusion of the medication or fluid and does not include removal of

the intravenous access device.

      (7) "Fibrinolytic agent" means

a pharmaceutical agent capable of dissolving blood clots.

      (8) "Intravenous access device"

means either a peripheral access device or a central venous access device.

      (9) "Mix" or "mixing"

means to combine two (2) or more medications or solutions, and includes

reconstituting a powder into a liquid, and diluting a medication or solution.

      (10) "Moderate sedation" means

the administration of intravenous medications to produce a state that intentionally

results in a depressed level of consciousness in a patient.

      (11) "Peripheral access device"

means a peripherally-inserted intravenous catheter or needle that is less than

or equal to three (3) inches in length.

      (12) "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.

      (13) "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.

      (14) "Push" means

administration of medication under pressure via a syringe.

      (15) "Supervision" means the

provision of guidance by a registered nurse, advanced practice registered

nurse, 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.

      (16) "Supervisor" means the

registered nurse, advanced practice registered nurse, physician or dentist who

provides supervision of the licensed practical nurse’s practice as defined in

subsection (15) of this section.

      (17) "Therapeutic phlebotomy"

means a clinical procedure whereby blood volume is reduced to achieve a

therapeutic outcome.

      (18) "Titration" means

adjustment of a medication dosage or rate of solution infusion as prescribed

within a therapeutic range that is based on the assessment of a patient.

      (19) "Vesicant" means an agent

capable of causing injury if it escapes from the intended vascular pathway into

surrounding tissue.

 

      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 September 15, 2004; 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 LPN’s 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 "Infusion Nursing: Standards

of Practice" and shall include the following components:

      (a) Technology and clinical applications;

      (b) Fluid and electrolyte balance;

      (c) Pharmacology and vesicants;

      (d) Infection control;

      (e) Transfusion therapy;

      (f) Parenteral nutrition; and

      (g) Legal aspects based on KRS 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 practice registered nurse (APRN),

physician, or dentist.

      (2) 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 provide supervision of the LPN’s

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 LPN’s 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 heparinized

saline 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

physician, physician assistant, dentist, or advanced practice registered nurse

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

LPN’s 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 via central venous and peripheral access devices as permitted by

this section and not prohibited by Section 6 of this administrative regulation;

      (b) Performance of site care and

maintenance that includes:

      1. Monitor access site and infusion

equipment;

      2. Change administration set, including

add-on device and tubing;

      3. Flushing; and

      4. Change site dressing;

      (c) Discontinuance of a medication or

fluid infusion; and

      (d) Conversion of a continuous infusion

to an intermittent infusion;

      (4) Insertion or removal of a peripheral

access device;

      (5) Administration, monitoring, 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, APRN, physician, dentist, or

pharmacist or are commercially prepared;

      (7) Mixing and administration via push or

bolus route of any of the following classifications of medications:

      (a) Analgesics;

      (b) Antiemetics;

      (c) The antagonistic agents for

analgesics;

      (d) Diuretics;

      (e) Corticosteroids; and

      (f) Saline, heparinized saline, or

Heplock solution to maintain patency of an IV access device;

      (8) Administration of glucose to patients

fourteen (14) years of age or older via direct push or bolus route;

      (9) Administration, monitoring, and

discontinuance of IV medications and fluids given via a patient controlled administration

system;

      (10) Administration, monitoring, and discontinuance

of parenteral nutrition and fat emulsion solutions;

      (11) Performance of dialysis treatment,

including:

      (a) Administering Heparin 1:1000 units or

less concentration either to prime the pump, initiate treatment, or for

administration throughout the treatment, in an amount prescribed by a

physician, physician’s assistant, or advanced practice registered nurse. The

licensed practical nurse shall not administer Heparin in concentrations greater

than 1:1000; and

      (b) Administering normal saline via the

dialysis machine to correct dialysis-induced hypotension based on the

facility’s medical protocol. Amounts beyond that established in the facility’s

medical protocol shall not be administered without direction from a registered

nurse or a physician;

      (12) Collection of blood specimens from a

peripheral IV access device only at the time of initial insertion;

      (13) Removal of a noncoring needle from

an implanted venous port;

      (14) Titration of intravenous analgesic

medications for hospice patients;

      (15) Administration of peripheral

intravenous medications via a volumetric control device;

      (16) Administration of intravenous

medications or solutions via a ready-to-mix intravenous solution infusion

system;

      (17) Aspiration of a central venous

catheter to confirm patency via positive blood return; and

      (18) Administration of medications or

fluids via:

      (a) Peripherally inserted central

catheters; or

      (b) Implanted or tunneled central venous

catheters.

 

      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 access

device used for hemodynamic monitoring;

      (3) Administration of medications or

fluids via arterial lines or implanted arterial ports;

      (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

agent to declot any IV access device;

      (6) Administration of medications

requiring titration, except as permitted by Section 5(14) of this

administrative regulation;

      (7) Insertion or removal of any IV access

device, except as permitted by Section 5(4) or (13) of this administrative

regulation;

      (8) Accessing or programming an implanted

IV infusion pump;

      (9) Administration of IV medications for

the purpose of procedural sedation, moderate 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 access device;

      (13) Mixing of any medications other than

those listed in Section 5(7) of this administrative regulation;

      (14) Insertion of noncoring needles into

an implanted port;

      (15) Performance of therapeutic

phlebotomy;

      (16) Administration of medications or

fluids via a nontunneled, nonimplanted central venous catheter;

      (17) Aspiration of an arterial line;

      (18) Withdrawal of blood specimens via a

central venous catheter; or

      (19) Initiation and removal of a

peripherally inserted central, midclavicular, or midline catheter.

 

      Section 7. Incorporation by Reference.

(1) The following material is incorporated by reference:

      (a) "Policies and Procedures for

Infusion Nursing", Fourth Edition, 2011; and

      (b) "Infusion Nursing: Standards of Practice",

2011.

      (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.

9-15-2004; 32 Ky.R. 2324; 33 Ky.R. 382; eff. 9-1-2006; 36 Ky.R. 2073-A; 2312;

eff. 6-15-2010; TAm eff. 7-15-2010; 37 Ky.R. 2446; 2830; eff. 6-15-2011; 38

Ky.R. 1764; 1945; eff. 6-20-2012.)
Read Entire Law on www.lrc.ky.gov