3 CCR 716-1.9 - RULES AND REGULATIONS FOR THE LICENSED PRACTICAL NURSE IN RELATION TO IV THERAPY
A.
BASIS: The Rules contained in this Rule 1.9 are adopted pursuant
to authority granted the Board by sections
12-255-101 to 134, C.R.S., as
amended, and specifically pursuant to authority granted in section
12-255-107(1)(e),
C.R.S., as amended.
B.
PURPOSE: These Rules are adopted to set forth the guidelines for
the Licensed Practical Nurse (LPN) related to the individual's role in
intravenous therapy and venous blood sampling. The patient care
responsibilities of LPNs should be within the parameters of their educational
preparation and their demonstrated abilities. Therefore, LPNs and their
supervisors have a joint responsibility to assure that LPNs practice within the
scope of their educational basis and demonstrated abilities.
C.
DEFINITIONS:
For the purposes of Rule 1.9, the following terms have the indicated meaning:
1.
"Adult Client" is an individual whose chronological age is thirteen years or
older.
2. "Board" is the State
Board of Nursing.
3. "Direct
Injection" is the administration of a drug directly into the Venous Access
Device or through the proximal port on a continuous infusion set.
4. "Intravenous Fluids" means fluids
containing one or more of the following elements: dextrose 5%; normal saline;
lactated ringers; sodium chloride 0.45%; or sodium chloride 0.2%.
5. "Peripheral Veins" are the veins not in
the chest, neck or abdomen.
6.
"Pre-mixed" means IV solution prepared and labeled by an authorized licensed
professional or manufacturer. Manufacturer prepared solutions include those
closed systems requiring activation to administer.
7. "Supervision" means a professional nurse,
physician, dentist, or podiatrist is physically present or accessible by some
form of telecommunication.
8. Types
of "Venous Access Devices":
a. Peripheral
catheters
(1) "Peripheral short catheter" is
a Venous Access Device less than 3 inches (7.5 cm) in length.
(2) "Peripheral midline catheter" means a
peripherally inserted catheter whose tip terminates no further than the axilla
and is between 3 inches and 8 inches (7.5 cm and 20 cm) in
length.
b. Central
catheters
(1) "PICC (peripherally inserted
central catheter)" means an IV catheter whose tip terminates in the superior
vena cava and is confirmed by chest x-ray.
(2) "Central catheter" means an IV catheter
whose tip terminates in the superior vena cava and may be either tunneled,
implanted, or percutaneously inserted, and is confirmed by chest
x-ray.
D.
SCOPE OF PRACTICE OF THE LICENSED
PRACTICAL NURSE IN RELATION TO IV THERAPY
1. The patient care responsibilities of the
LPN should be within the parameters of their educational preparation and their
demonstrated abilities.
2. An LPN
may perform the following procedures under the Supervision of a professional
nurse, physician, dentist, or podiatrist:
a.
Calculate and observe flow rate of intravenous infusions;
b. Stop the flow of Intravenous Fluids, as
defined in Sections (C)(5) and (C)(10) of Rule 1.9;
c. Remove peripheral short catheter for Adult
Clients;
d. Report and document
observations and procedures relating to intravenous infusion and insertion
sites;
e. Utilize Peripheral Veins
for intravenous access with a peripheral short catheter;
f. Perform blood sampling from a peripheral
vein or through a central Venous Access Device using a syringe or vacutainer
device.
g. Reconstitute IV
antibiotics following pharmacy instructions and/or organizational
policies.
h. Administer the
following:
(1) Intravenous Fluids through
Venous Access Devices;
(2)
Pre-mixed Intravenous Fluids containing electrolytes and vitamins;
(3) Pre-mixed antibiotic solutions via Venous
Access Devices delivered per labeled instructions by gravity flow, pump or
Direct Injection for a period of time consisting of greater than five minutes
in duration; and/or
(4) The first
dose of IV antibiotic therapy under the observation of a professional nurse,
physician, podiatrist, or dentist who is present in the same patient care
area.
i. Regulate the
prescribed flow rate of the Intravenous Fluids;
j. Monitor the systemic effects of
intravenous therapy;
k. Flush
Venous Access Devices designed to maintain venous patency with normal saline or
a sub-therapeutic dosage of heparin;
l. Change dressings and/or caps to Venous
Access Devices; and/or
m. Switch
from continuous infusion of Intravenous Fluid to heparin/saline lock
E.
OUTSIDE THE
SCOPE OF PRACTICE FOR LICENSED PRACTICAL NURSES IN RELATION TO IV
THERAPY
1. A licensed practical nurse
may not perform any of the following procedures as they are outside the LPN's
scope of practice:
a. Administration of IV
medications, except as allowed in Section (D)(2)(g) of Rule 1.9;
b. Access or de-access implanted central
venous access ports;
c. Insertion
of a PICC line or a peripheral midline catheter;
d. Repair of Venous Access Devices;
e. Remove a central venous access
catheter;
f. Administration of
parenteral nutrition solutions;
g.
Administration of blood and blood products;
h. Administration of chemotherapy intravenous
medications/solutions;
i.
Administration of thrombolytic agent to declot a catheter; and/or
j. Direct Injection of any IV medication for
a period of time consisting of five minutes or less in duration.
Adopted April 22, 2009
Revised April 26, 2012
Effective July 1, 2012
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
A. BASIS: The Rules contained in this Rule 1.9 are adopted pursuant to authority granted the Board by sections 12-255-101 to 134, C.R.S., as amended, and specifically pursuant to authority granted in section 12-255-107(1)(e), C.R.S., as amended.
B. PURPOSE: These Rules are adopted to set forth the guidelines for the Licensed Practical Nurse (LPN) related to his/her role in intravenous therapy and venous blood sampling. The patient care responsibilities of LPNs should be within the parameters of their educational preparation and their demonstrated abilities. Therefore, LPNs and their supervisors have a joint responsibility to assure that LPNs practice within the scope of their educational basis and demonstrated abilities.
C. DEFINITIONS:
For the purposes of Rule 1.9, the following terms have the indicated meaning:
1. "Adult Client" is an individual whose chronological age is thirteen years or older.
2. "Approved IV Therapy Course/Program" is an IV Therapy Course/Program, as defined in paragraph (7), and accepted by the Board , that includes theory/lab and clinical practice related to the knowledge, skills and ability to perform IV therapy and venous blood sampling, and also meets the standards set in Section (G) of Rule 1.9.
3. "Board " is the State Board of Nursing.
4. "Direct Injection" is the administration of a drug directly into the Venous Access Device or through the proximal port on a continuous infusion set.
5. "Intravenous Fluids" means fluids containing one or more of the following elements: dextrose 5%; normal saline; lactated ringers; sodium chloride 0.45%; or sodium chloride 0.2%.
6. "IV Authority" refers to Board granted permission to practice IV therapy and venous blood sampling.
7. "IV Therapy Course/Program" prepares the LPN to perform IV therapy and venous blood sampling, utilizing Venous Access Devices, as defined in paragraph (12), on the Adult Client within the scope of practice, as defined in Section (D).
8. "Peripheral Veins" are the veins not in the chest, neck or abdomen.
9. "Preceptor" is a licensed professional or a licensed practical nurse with IV Authority, employed by a healthcare agency, who assumes joint teaching responsibility with the clinical instructor, when the instructor is not present in the setting.
10. "Pre-mixed" means IV solution prepared and labeled by an authorized licensed professional or manufacturer. Manufacturer prepared solutions include those closed systems requiring activation to administer.
11. "Supervision" means a professional nurse, physician, dentist, or podiatrist is physically present or accessible by some form of telecommunication.
12. Types of "Venous Access Devices":
a. Peripheral catheters
(1) "Peripheral short catheter" is a Venous Access Device less than 3 inches (7.5 cm) in length.
(2) "Peripheral midline catheter" means a peripherally inserted catheter whose tip terminates no further than the axilla and is between 3 inches and 8 inches (7.5 cm and 20 cm) in length.
b. Central catheters
(1) "PICC (peripherally inserted central catheter)" means an IV catheter whose tip terminates in the superior vena cava and is confirmed by chest x-ray.
(2) "Central catheter" means an IV catheter whose tip terminates in the superior vena cava and may be either tunneled, implanted, or percutaneously inserted, and is confirmed by chest x-ray.
D. SCOPE OF PRACTICE OF THE LICENSED PRACTICAL NURSE WITH IV AUTHORITY
1. The patient care responsibilities of the LPN should be within the parameters of their educational preparation and their demonstrated abilities.
2. A LPN with IV Authority may perform the following procedures under the Supervision of a professional nurse, physician, dentist, or podiatrist:
a. Calculate and observe flow rate of intravenous infusions;
b. Stop the flow of Intravenous Fluids, as defined in Sections (C)(5) and (C)(10) of Rule 1.9;
c. Remove peripheral short catheter for Adult Clients;
d. Report and document observations and procedures relating to intravenous infusion and insertion sites;
e. Utilize Peripheral Veins for intravenous access with a peripheral short catheter;
f. Perform blood sampling from a peripheral vein or through a central Venous Access Device using a syringe or vacutainer device.
g. Reconstitute IV antibiotics following pharmacy instructions and/or organizational policies.
h. Administer the following:
(1) Intravenous Fluids through Venous Access Devices;
(2) Pre-mixed Intravenous Fluids containing electrolytes and vitamins;
(3) Pre-mixed antibiotic solutions via Venous Access Devices delivered per labeled instructions by gravity flow, pump or Direct Injection for a period of time consisting of greater than five minutes in duration; and/or
(4) The first dose of IV antibiotic therapy under the observation of a professional nurse, physician, podiatrist, or dentist who is present in the same patient care area.
i. Regulate the prescribed flow rate of the Intravenous Fluids;
j. Monitor the systemic effects of intravenous therapy;
k. Flush Venous Access Devices designed to maintain venous patency with normal saline or a sub-therapeutic dosage of heparin;
l. Change dressings and/or caps to Venous Access Devices; and/or
m. Switch from continuous infusion of Intravenous Fluid to heparin/saline lock
E. OUTSIDE THE SCOPE OF IV AUTHORITY
1. A licensed practical nurse with IV Authority may not perform any of the following procedures as they are outside the LPN's scope of practice:
a. Administration of IV medications, except as allowed in Section (D)(2)(g) of Rule 1.9;
b. Access or de-access implanted central venous access ports;
c. Insertion of a PICC line or a peripheral midline catheter;
d. Repair of Venous Access Devices;
e. Remove a central venous access catheter;
f. Administration of parenteral nutrition solutions;
g. Administration of blood and blood products;
h. Administration of chemotherapy intravenous medications/solutions;
i. Administration of thrombolytic agent to declot a catheter; and/or
j. Direct Injection of any IV medication for a period of time consisting of five minutes or less in duration.
F. REQUIREMENTS FOR OBTAINING IV AUTHORITY
1. Successful completion of an Approved IV Therapy Course/Program is required if:
a. The LPN's IV Authority was removed on January 1, 2006, or;
b. The LPN had not received IV Authority prior to January 1, 2006, or;
c. The LPN's basic practical nursing program did not include an Approved IV Therapy Course/Program.
2. Upon the successful completion of an Approved IV Therapy Course/Program, the applicant must:
a. Possess an active, unencumbered Colorado or multi-state practical nurse license.
b. Submit an IV Authority application on a current Board approved form, and pay the applicable fee.
c. Verify completion of an Approved IV Therapy Course/Program through a Board approved competency checklist.
3. An applicant by Endorsement of IV Authority from another state or territory of the United States must:
a. Possess an active, unencumbered Colorado or multi-state practical nurse license.
b. Upon endorsement for licensure, submit an IV Authority application on a current Board approved form, and pay the applicable fee.
c. Submit proof of successful completion of an Approved IV Therapy Course/Program.
4. United States military personnel who have education and training documented on an official transcript and determined to be substantially equivalent, as determined by the Board , to the Approved IV Therapy Course/Program curriculum requirements in Rule 1.9 Rules and Regulations for the Licensed Practical Nurse in Relation to IV Authority will be eligible to IV Authority as provided for in section 12-20-202(4), C.R.S., and are subject to requirements of section (F)(2) of this Rule 1.9.
G. STANDARDS FOR IV THERAPY/VENOUS BLOOD SAMPLING COURSES
1. Curriculum for IV Therapy Course/Program shall:
a. Provide adequate theory and supervised clinical practice in IV therapy related to the Adult Client necessary for the performance of nursing functions, as outlined in Section (D) of Rule 1.9.
b. Provide the following content:
(1) Legal implications and scope of practice.
(2) Role of the licensed practical nurse in intravenous therapy.
(3) Related anatomy and physiology, including the physiology of aging and site selection.
(4) Fluids and electrolytes.
(5) Commonly used Intravenous Fluids.
(6) Hazards and complications of IV therapy, local and systemic.
(7) Psychological aspects of venipuncture.
(8) Infection control measures.
(9) Identifying types of Venous Access Devices.
(10) Monitoring Venous Access Devices.
(11) Dressing and cap changes.
(12) Initiating, monitoring, regulating, replacing, and discontinuing Intravenous Fluids.
(13) Use of appropriate equipment, including IV pumps.
(14) Drug incompatibilities.
(15) Administration of Pre-mixed vitamins and electrolytes.
(16) Pharmacology of heparin and antibiotics.
(17) Administration of Pre-mixed IV antibiotics.
(18) Flushing of Venous Access Devices designed to maintain venous patency.
(19) Collection of venous blood specimens from Peripheral Veins and central Venous Access Devices for tests and use of appropriate equipment for same.
(20) Nursing care, intervention, reporting and documentation related to intravenous therapy/venous blood sampling.
c. Each student shall complete clinical practice or simulated clinical practice related to:
(1) Peripheral short catheter insertion on Adult Clients.
(2) Initiation and monitoring of Intravenous Fluid administration on Adult Clients through Venous Access Devices.
(3) Flushes into Venous Access Devices designed to maintain venous patency for Adult Clients.
(4) Administration of Pre-mixed antibiotics via Venous Access Device to Adult Clients.
(5) Utilization of IV pumps.
(6) Peripheral venous blood sampling on Adult Clients.
(7) Discontinuation of peripheral short devices.
(8) Documentation of nursing actions and observations.
(9) Sterile dressing change on central Venous Access Devices.
(10) Blood collection from a central Venous Access Device.
d. At the discretion of the instructor, students may demonstrate knowledge and competency in skills with validation of previous IV therapy education.
e. The Board may review new IV Therapy Course/Program applications and approve IV Therapy Course/Programs that meet the standards set forth in Section (G)(1)(a-c) of Rule 1.9.
f. All Approved IV Therapy Courses/Programs shall submit an annual report on a Board approved form to demonstrate compliance with Rule 1.9. Failure to submit an annual report may result in withdrawal of Board approval.
H. WITHDRAWAL OF IV AUTHORITY
1. The Board may withdraw IV Authority if the Board has reasonable cause to believe that the nurse no longer meets the requirements for IV Authority as set forth in section (F) of this Rule 1.9, or the Board has reasonable cause to believe that the nurse is unable to practice IV Authority with reasonable skill and safety.
Adopted April 22, 2009
Revised April 26, 2012
Effective July 1, 2012