Nursing

Practice Alerts & Guidelines

The Practice of IV Therapy by Licensed Practical Nurses in Acute Care Settings

In response to numerous inquiries concerning the role of the licensed practical nurse (LPN) in the administration of intravenous therapy in acute care settings, the New York State Board for Nursing provides the following guidance document.

The role of the LPN in providing intravenous therapy is determined by a number of factors including the complexity of the procedure, the degree of direction, the setting, as well as the skill and competence of the licensee. A Registered Professional Nurse (RN) may delegate select activities associated with the administration of intravenous therapy to an appropriately competent LPN. The delegation of these activities is based on the RN's professional judgement, the competence of the LPN, policy and procedures of the institution and standards of nursing practice. Regardless of the degree of delegation, however, the RN retains the ultimate responsibility for the administration and clinical management of intravenous therapy, including assessment of the patient for symptoms and reactions. Education Law does not permit LPNs to make any patient assessments (interpret or evaluate clinical data). In the opinion of the State Board for Nursing, the practice of intravenous therapy by LPNs in acute care settings requires RN supervision, that is, the RN responsible for the LPN must be assigned to the patient care unit at all times when intravenous therapy is being provided by the LPN. The RN must document, at least every shift, assessment of the patient's condition relative to the intravenous therapy.

Facilities must ensure that LPNs allowed to perform intravenous therapy procedures have satisfactorily completed an initial training program, received supervised clinical experiences, demonstrated competence in the performance of intravenous therapy, are appropriately supervised by RNs and complete an annual IV therapy update. It is appropriate for IV competency evaluation to be included in the annual performance review of each licensee.

The accompanying chart displays select tasks that can be performed by an LPN practicing in acute care settings, under appropriate supervision, who has demonstrated competency in intravenous therapy administration. The chart also includes advanced technical procedures that require assessment and critical analysis skills that are beyond the scope of practice of LPNs and that cannot be performed by an LPN regardless of the degree of education, experience or supervision. A glossary is also provided defining terms used in the chart.

For additional information, including a document on the practice of IV therapy by LPNs in Long Term Care Settings, please contact the State Board for Nursing by mail: New York State Education Building - Office of the Professions, 89 Washington Ave., Board for Nursing Office, Second Floor, West Wing, Albany, NY 12234, phone: 518-474-3817, extension 120, or e-mail: nursebd@mail.nysed.gov.

Definition of Terms

Venous Access Device/Line:

Any centrally or peripherally inserted venous infusion device/line.

Central Venous Device/Line:

Any infusion device whose distal end is placed in the central venous system. These devices may be tunneled, non-tunneled, or implanted. Insertion sites may be peripheral, for example, peripherally inserted central catheter (PICC) lines or central. Examples include various ports, triple lumen, "BROVIAC"®, and "HICKMAN"® catheters, etc. ("HICKMAN" and "BROVIAC" are registered trademarks of C. R. Bard, Inc. and its related company, BCR, Inc.)

Central Venous Chest Port:

Implanted central venous line devices for long term IV therapy.

Central Venous Arm Port:

Peripherally implanted central venous line devices for long term IV therapy.

Midline Catheters:

Long-line peripherally inserted venous access devices. Such devices do not have their distal end in the central venous system. These devices are used to infuse only isotonic drugs or fluid.

SASH:

Saline administration, saline, heparin flush procedure.

SAS:

Saline administration, saline, flush procedure.