|
State |
Statement Allowing LPNs/LPNs
to Administer IV Medications |
Statement Specific to Hemodialysis |
| Alabama |
General
Statement section 610-X-6-.04 of
regulations: “Provision
of care using standardized procedures
including administration of medications
and treatments under the direction
of licensed professional nurse…” |
- Statement: “Chronic
Hemodialysis by Licensed Practical
Nurses”
“…it is within the scope of practice
of licensed practical nurses to
perform hemodialysis…”
including, “initiation of
dialysis treatment at peripheral
sites; performance of intravenous
therapy…, including connection
of IV fluids/ “piggyback”
solutions to existing central
venous infusions; flushing of
central venous ports and alteration
of fluid rates by LPNs with two
years experience in initiating
peripheral IV therapy; monitoring
of dialysis treatment; adjustment
of dialysis treatment at the direction
of physician or registered nurse;
termination of dialysis treatment…”
“Functions under the supervision
of a registered nurse, i.e., RN
physically present in the facility.”
|
| Alaska |
Alaska
advocates the use of the National
Council’s Delegation process
to determine what LPNs can do.
Using the example of “hanging
a premixed medicated intravenous
solution”, they go on to State
that, “Activities that fit
the decision making model depicted
in Figure 1 are appropriate areas
for expanded practice by experienced
LPNs.” |
The Alaska
Board uses “management of
chronic dialysis care in the health
care facility setting” as
another example of a task that can
be appropriately delegated to LPNs. |
| Arizona |
LPNs allowed
to administer IV meds. |
|
| Arkansas |
LPNs are
not taught IV therapy in the Education
Program. The RN may delegate
this task to an LPN provided the
LPN has had postgraduate education
and competency validation.
They cannot perform any task that
requires “specialized knowledge,
skill or judgment of an RN, “e.g.
cancer chemotherapy or any medication
that requires assessment/monitoring,
as assessment is not in the LPN
scope of practice. |
No |
| Colorado |
“Intravenous
therapy and venous blood withdrawal
is a part of the expanded role of
the LPN.” In addition
to other activities, LPNs may administer,
“pre-mixed antibiotic solutions
via peripheral veins regulated by
gravity flow or pump.” |
No |
| Connecticut |
May initiate
IV therapy, maintain continuous
therapy and administer IV medications
(except IV push medications) with
special post-basic training, demonstrated
competence and availability of ongoing
supervision. |
No |
| Delaware |
Board’s
position paper recognizes initiation
and maintenance of peripheral therapy
(including IV medications, except
by push) They have limited
central line activities (not delineated
by Board in our response.) |
No |
| Florida |
LPNs can
administer IV medications. |
|
| Georgia |
No restrictions
on LPN's administering IV medications. |
|
| Idaho |
“The licensed
practical nurse implements aspects
of the strategy of care by:…Performing
peripheral intravenous therapy functions
as follows…Hanging containers of
medicated or unmedicated intravenous
solutions which are commercially
prepared or pre-mixed by pharmacy,
hanging blood or blood derivatives,
inserting analgesic cartridges and
programming and monitoring patient
controlled analgesia pumps and performing
autoinfusion” |
“The licensed
practical nurse implements aspects
of the strategy of care by:…Performing
a variety of procedures including
but not limited to: application
of monitoring equipment, recording
of readings and hemodialysis or
peritoneal dialysis.” |
| Illinois |
|
The letter
of the Illinois Nurse Practice Act
States that the LPN does not give
IVP medications. However, it is
standard practice in the Nephrology
Community for LPN's with IV certification
to give Dialysis specific IVP medications.
They are not allowed to co-sign
or administer blood or blood products |
| Indiana |
“Indiana
does not have specific laws defining
the scope of practice for Practical
Nurses. The law just basically
States that a nurse can perform
functions that they are trained
to do and those in which the facility
allows them to do.”
Kristen Kelley – Indiana
Board of nursing. |
|
| Iowa |
“Iowa Administrative
Code 655.6.5(3) authorizes the licensed
practical nurse to perform procedures
related to the expanded scope of
administration of intravenous therapy
in a licensed hospital, a licensed
skilled nursing facility and a certified
end-stage renal dialysis unit”
after taking a Board-approved post-graduate
course. LPNs may initiate
peripheral IV therapy, administer
premixed electrolyte and vitamin
solutions and premixed antibiotic
solutions – all of these after the
initial dose is administered by
an RN. |
See Statement
re IV meds. |
| Kansas |
After post-graduate
training the LPN may, administer
“continuous intravenous drip
analgesics and antibiotics…administer
by direct intravenous push analgesics,
antibiotics, antiemetics and diuretics.” |
No |
| Kentucky |
“When delegated
by a registered nurse, the licensed
practical nurse may administer IV
medications and fluids that are:
(a) mixed and labeled by a registered
nurse or pharmacist or are commercially
prepared; and (b) given on a routine
reoccurring basis to a patient with
a stable condition.” |
“LPNs who
provide dialysis care may:
- Collect assessment
data;
- Cannulate and
perform dialysis treatment via
an implanted subcutaneous vascular
device, and/or peripheral access
sites (AV fistulas and AV grafts).
- Administer heparin
1:1000 units or less concentration…
- Administer normal
saline via the dialysis machine
to correct dialysis induced hypotension
based upon pre-approved medical
protocol
- Administer intravenous
therapy/ medications” as
listed in “Statement Allowing
LPNs/LPNs to Administer IV Medications”
in this table.
|
| Louisiana |
“Scope
of practice is a fluid concept.
It changes as knowledge and technology
expand. LPNs must possess
the knowledge, skill, and ability
to perform their duties, therefore,
scope of practice comes down to
the competency of the individual
LPN….Some of the tasks an LPN may
perform when the above conditions
are met…
Initiate and maintain IV therapy
and administer IV medications by
IVPB and/or IVP (including hyperalimentation,
blood and blood products)…Perform
heparinization during hemodialysis…Care
for clients with external venous
catheters and specifically:
obtain blood specimens/connect and
monitor IV fluids/connect IVPB,
provide site care (including dressing
changes) |
See Statement
re IV meds. |
| Maine |
Must have
IV certification course [could not
access more detailed information] |
“…a licensed
practical nurse may administer a
heparin bolus as part of the procedure
for initiating dialysis in a renal
dialysis center.” |
| Maryland |
“The LPN
may perform the following infusion
therapy acts for peripheral and
subcutaneous infusion when there
is an RN on site or available by
telephone…Administer a medication
which is routine for the patient…Administer
medication via a peripheral IV line
(including midline) using: (a) pharmacy-prepared
medication; and (b) PPN solutions;
and Add medications to an intravenous
solution.”
“The LPN may perform the following
additional acts under the direct
supervision of the RN following
a comprehensive patient assessment:
(1) Administer medication and TPN
via midclavicular or CVC by hanging
pharmacy-prepared solutions; (2)
Add medication to a solution administered
via a midclavicular or CVC; (3)
Administer medication and subsequent
replacement solutions including
TPN via implanted ports.”
“On completion of a second specialized
educational program…and with documented
evidence of clinical competency,
the LPN may administer standardized
doses of non-vesicant chemotherapeutic
agents and antiviral agents.” |
No |
| Massachusetts |
LPNs may
administer IV medications with the
exception of IV medications used
during conscious sedation.
"The measurement of competency
and whether the LPN is allowed this
practice is given to the facility
to determine. Our regs say
that it is within the SOP.” |
No |
| Michigan |
|
In Michigan,
LPN's can give IV meds as long as
they have the Medication class and
certificate. They may not administer
blood but can give all other drugs. |
| Minnesota |
LPNs are
allowed to give IV medications. |
|
| Mississippi |
LPNs are
allowed to give IV medications |
|
| Missouri |
LPNs are
allowed to give IV medications. |
|
| Montana |
“Any of
the following IV therapy tasks related
to peripheral vessel IVs may be
performed by the practical nurse:…mix
medication solution from a unit
dose vial and add to IV solution
or volutrol; hang medication solutions
that are pre-mixed and properly
labeled by a registered nurse or
pharmacist; administer metered dose
of medication by way of a patient
controlled analgesia pump…”
“Any of the following tasks related
to central venous lines may be performed
by a practical nurse:…change standard
solutions on continuous flow, pre-established
central line system.” |
“Under
the direct supervision of a dialysis
RN, an LPN may perform hemodialysis
procedures that include: (a)
arterio-venous fistula/graft needle
insertion; (b) administration of
prescribed local anesthesia as needed
prior to dialysis needle insertion;
(c)accessing, blood draws, flushes
and dressing changes of hemodialysis
central-venous catheters; (d) administration
of prescribed doses of routine dialysis
heparin.” |
| Nebraska |
“A licensed
practical nurse-certified may perform
limited intravenous therapy interventions
under the direction of a registered
nurse or licensed practitioner…
When under the direct supervision
of an RN or licensed practitioner,
an LPN-C may perform these activities
for an adult client: (1) Infuse
intravenous fluids and administer
approved medications into a continuous
flow central line..
“Approved medications” Approval
determined by RN or MD delegating
the task. |
“The Nebraska
Board supports the ANNA Position
Statement on Delegation of Nursing
Tasks and the ANNA Position Statement
on Use of Unlicensed in Dialysis.”
The Board supports administration
of heparin but does not support
administration of other IV medications
in dialysis setting. |
| Nevada |
“A licensed
practical nurse who has at least
1 year of experience in nursing
after receiving his initial license,
who has completed a course in intravenous
therapy approved by the Board…,
and who acts pursuant to a written
order of a physician and under the
immediate supervision of a physician
or registered nurse may:…
Administer antibiotics or histamine
H2 receptor antagonists by adding
a solution by piggyback…” |
No |
| New Hampshire |
LPNs may
administer intravenous “medications
and nutrients to intravenous fluids
after the initial dose is administer
by the registered nurse…Add
medications and nutrients to fluids
previously premixed by a registered
pharmacist or the pharmaceutical
manufacturer after the initial dose
is administered by the registered
nurse…” |
No |
| New Jersey |
“LPNs need
to be competent to perform the delegated
task of initiating and administering
IV therapy (excluding IV push medications).” |
No |
| New Mexico |
LPNs are
allowed to give IV medications. |
|
| New York |
“…a licensed
practical nurse, who has demonstrated
knowledge, skills and competency
in intravenous therapy, MAY,
while practicing in an acute care
setting under appropriate supervision:…
Add medications except chemotherapy
to IV solutions for infusion through
vascular access devices.” |
No |
| North Carolina |
“Administration
of IV fluids and medications via
the central vascular route is within
the scope of nursing practice for
the registered nurse and the licensed
practical nurse.”
“Administration of IV fluids and
medications via the peripheral vascular
route is within the scope of practice
for the licensed practical nurse.” |
No |
| North Dakota |
“The North
Dakota Board of Nursing authorizes
the provision of selected components
of intravenous therapy by a Licensed
Practical Nurse who has completed
a board approved educational program
that included intravenous therapy
in the curriculum or has successfully
completed a course in intravenous
therapy…”
“The role of the Licensed Practical
Nurse in the nursing management
of intravenous therapy of a stabilized
client is to:… Add prescribed medications
to intravenous fluids to administer
through existing peripheral lines
and central venous lines having
external access.”
“Administer selected medications
by intravenous bolus according to
specific institutional policies
and after specific institutional
inservice.” |
“The Licensed
Practical Nurse may perform the
following nursing functions in a
dialysis unit according to specific
institutional policy and after completion
of specific institutional inservice:…
Administer IV medications and solutions
during hemodialysis.” |
| Ohio |
After completing
a course in intravenous therapy
approved by the Board the LPN may
“initiate or maintain an intravenous
piggyback infusion containing an
antibiotic additive.” |
“…at the
direction of a physician or a registered
nurse, a licensed practical nurse
authorized by the board to perform
intravenous therapy may perform
the following activities for the
purpose of performing dialysis:
- The routine administration
and regulation of saline solution
for the purpose of maintaining
an established fluid plan;
- The administration of a heparin
dose intravenously;
- The administration of a heparin
dose peripherally via a fistula
needle;
- The loading and activation
of a constant infusion pump or
the intermittent injection of
a dose of medication prescribed
by licensed physician for dialysis.”
|
| Oklahoma |
“IV therapy
and medication administration may
be within the scope of practice
of the LPN who has appropriate educational
training and under supervision.” |
No |
| Oregon |
“The Board
recognizes that the role of the
licensed practical nurse and registered
nurse will change over time.
Basic education which leads to licensure
as a licensed practical nurse of
registered nurse establishes entry
level competencies. The licensee
may add technical skills to practice
following initial licensure through
such methods as inservice education,
on the job training or continuing
education.” Oregon does not
publish a laundry list of tasks
that are within the LPN scope of
practice. |
No |
| Pennsylvania |
LPNs may
administer IV medications except
for antineoplastic agents, titrated
medication and intravenous push
medications other than heparin flush. |
No |
| Rhode Island |
“There
is nothing in statute or regulations
to preclude an LPN from administering
IV therapy or medication.
The employing agency decides which
level of caregiver (RN or LPN) may
perform this task and to assure
the individual is competent to perform
task.” |
No |
| South Carolina |
|
South Carolina
requires an IV certification course |
| South Dakota |
LPNs may,
“Administer, by peripheral
route, standard solutions at a defined
flow rate, with or without admixtures,
mixed and labeled by a pharmacist,
registered nurse or physician…Administer
vitamins, antibiotics, corticosteroids,
and H2 antagonists by the intravenous
piggyback route, that are mixed
and labeled by a pharmacist, registered
nurse, or physician, excluding the
first dose which must be administered
by a registered nurse.”
Administer “via an externally
accessed centrally place catheter…standard
solutions at a defined flow rate,
with or without admixtures, mixed
and labeled…”
“Administer vitamins, antibiotics,
corticosteroids, and H2 antagonists
by the intravenous piggyback route,
that are mixed and labeled by a
pharmacist, registered nurse, or
physician, excluding the first dose
which must be administered by a
registered nurse.” |
No |
| Texas |
LPNs may
administer intravenous medications
both peripherally and via central
lines after education that includes
competencies specific to those functions. |
No |
| Utah |
LPNs may
administer IV medications after
taking a post-graduate certification
course. |
No |
| Virginia |
|
LPN's can
administer all med's utilized in
dialysis, IV included. They cannot,
however, administer blood without
an RN second signature. |
| Washington |
“Licensed
Practical Nurses (PN) may, under
the supervision of a registered
nurse, administer intravenous medications
and fluids provided the LPN has
had the appropriate continuing education
and practice to prepare to administer
these procedures safely and competently.”
“The LPN may perform administration
of fluids, medication, Total Parenteral
Nutrition (TPN), blood or blood
products via central venous catheters
and central lines, access these
lines for blood draws and administration
of emergency cardiac medications
via IV push”…if there are strict
guidelines and protocols in place.” |
No |
| West Virginia |
“The registered
nurse may delegate selected activities
associated with the administration
and management of intravenous therapy
to a licensed practical nurse qualified
by education and experience.”
Based on this, LPNs do administer
IV medications. |
No |
| Wisconsin |
“We don’t
do laundry lists of tasks-they may
be delegated acts according to their
education/training and experience.”
Intravenous therapy, including administration
of intravenous medications, “are
considered either delegated medical
acts or delegated nursing acts from
an RN.” |
No |
| Wyoming |
LPNs may
administer IV medications after
completing an IV Therapy Certification
course. |
No |
