Role of LPN in IV Therapy
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 that was developed according to board guidelines and approved by the board.
(Reference: NDCC 43-12.1-02(5); NDCC 43-12.1-08(1); NDAC 54-05-01(06)
The North Dakota Board of Nursing believes that a Licensed Practical Nurse who has the appropriate knowledge and skill may perform selected interventions in the nursing management of intravenous therapy of a stabilized client under the clinical assignment and supervision of a Registered Nurse, Advanced Practice Registered Nurse or Licensed Practitioner in accordance with facility policy. This knowledge/skill is an expected competency of the graduate of the associate degree program and practical nurses who completed vocational education programs and successfully completed a board approved certification program in intravenous therapy.
I. The role of the Licensed Practical Nurse in the nursing management of intravenous therapy of a stabilized client is to:
1. Initiate or discontinue intravenous fluids using peripheral veins.
2. Initiate intravenous therapy only with a needle or over the needle intravenous device used for short term intravenous therapy.
3. Monitor and regulate the infusion of prescribed intravenous solutions.
4. Observe, report, and document the client's responses to the intravenous therapy including the condition of the intravenous site.
5. Replace solution containers of prescribed intravenous fluids to existing peripheral lines and central venous lines having external access.
6. Add prescribed medications to intravenous fluids to administer through existing peripheral lines and central venous lines having external access.
7. Perform flushes of peripheral devices and central venous lines having external access with premixed solutions designed to maintain venous patency.
8. Perform sterile dressing changes to peripheral devices and central venous lines having external access.
9. Discontinue peripheral devices only.
10. Administer selected medications by intravenous bolus according to specific institutional policies and after specific institutional in-service. The institution /agency must determine by policy:
a. Drugs that may be given by the Licensed Practical Nurse by intravenous bolus.
b. Drugs that may be given in situations with direct, over the shoulder supervision by a Registered Nurse, Advanced Practice Registered Nurse or Licensed Practitioner.
c. Drugs that are not to be given by the Licensed Practical Nurse by intravenous bolus.
11. According to specific institutional policies and after specific institutional in-service the LPN may:
a. Withdraw blood from a central venous line.
b. Administer blood or blood products.
12. Licensed Practical Nurses who have successfully completed a board approved intravenous therapy course may withdraw venous blood from peripheral veins for laboratory analysis.
II. 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 in-service:
1. Perform venipuncture for the purpose of hemodialysis.
2. Initiation and discontinuation from dialysis utilizing the various accesses - including subclavian, internal jugular, femoral vein, fistula and right atrial catheters.
3. Withdraw blood and heparinized saline from the various accesses for the purpose of removing the heparin and establishing patency.
4. Withdraw blood from access for the purpose of obtaining blood for a lab specimen.
5. Administer IV medications and solutions during hemodialysis.
6. Flush tubing of access device. Perform dressing changes to various access device sites.
III. Licensed Practical Nurses who are IV certified and ACLS certified may give IV bolus medications in ACLS resuscitative situations under the direct supervision of a Registered Nurse, Advanced Practice Registered Nurse, or Licensed Practitioner according to agency policy.
IV. The Licensed Practical Nurse MAY NOT perform the following nursing functions in relation to intravenous medications and fluids:
1. Administer medications by intravenous bolus for moderate sedation.
2. Administer investigational or cytotoxic intravenous medications.
3. Discontinue a central venous line (this includes a peripherally inserted central catheter).
Guidelines for a certificate program in intravenous therapy for Licensed Practical Nurses are available from the Board of Nursing office. The program must be reviewed and approved by the Board of Nursing before the initial offering and every four years thereafter.