Practice Information

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


In response to numerous inquiries concerning the role of the licensed practical nurse (LPN) in the administration of intravenous therapy in long term care settings, the New York State Board for Nursing provides the following clarifying 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 long term care settings requires RN supervision, which must be on-site at all times that IV therapy is being provided by the LPN (long term care facilities must follow acute care guidelines on sub-acute units). The RN must document, at least every shift, assessment of the patient's condition relative to the intravenous therapy.

Facilities must ensure that LPNs permitted 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 long term 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 Acute 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@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.
The Practice of IV Therapy by Licensed Practical Nurses in Long Term Care Settings
  • The provision of IV therapy by an LPN must be under the on-site supervision of an RN at all times that the LPN is providing IV therapy. (Long term care facilities must follow acute care RN supervision guidelines on sub-acute units.)
  • LPNs may not independently provide IV therapy in Home Care settings.
An LPN MAY:
- Identify and set up equipment and solutions for infusion through any venous access device (peripheral or central line).
   
An LPN MAY:
- Start most peripheral IV lines
Except that: An LPN MAY NOT:
- Start any central venous line including PICC lines.
- Start a venous line using a midline catheter.
An LPN MAY:
- Monitor and adjust flow rates of any venous access device/line.
   
An LPN MAY:
- Administer medicated and unmedicated intravenous solutions through most venous access lines including midline catheters.
Except that: An LPN MAY NOT:
- Administer intravenous solutions through any implanted central venous chest port or implanted central venous arm port access device.
- Administer the first dose of any medicated IV solution through any venous access device.
- Administer oncology chemotherapy regimens infusion through venous access devices.
An LPN MAY:
- Administer intermittent IV medicated or unmedicated solutions through most venous access lines including midline catheters.
Except that: An LPN MAY NOT:
- Administer intermittent IV solutions through a central venous line, including a PICC line, central venous chest ports and central venous arm ports.
An LPN MAY:
- Administer ONLY saline and/or heparin flushes through a peripheral IV line by the direct IV push technique.
Except that: An LPN MAY NOT:
- Administer any medication (except saline and/or heparin flushes) by direct IV push.
- Administer an IV fluid bolus for plasma volume expansion (except in Hemodialysis as defined in Department of Health Regulations [400.15]).
An LPN MAY:
- Flush venous access lines for patency using the SASH or SAS flush procedure.
Except that: An LPN MAY NOT:
- Flush any central venous line for patency, including PICC lines, central venous chest ports or central venous arm port devices.
An LPN MAY:
- Change dressings on peripheral venous IV lines not directly connected to the central venous system.
Except that: An LPN MAY NOT:
- Change dressings and/or heparin lock caps on any central venous access device/line.
An LPN MAY:
- Draw blood from peripheral venous lines not directly connected to the central venous system.
Except that: An LPN MAY NOT:
- Draw blood from any central venous access device/line.
An LPN MAY:
- Discontinue and remove peripheral venous lines.
Except that: An LPN MAY NOT:
- Discontinue or remove any central venous access device/line including PICC lines.
Last Updated: January 31, 2013