The nursing laws and rules allow the competent and appropriately trained licensed practical nurse to perform infusion therapy. Invasive procedures require an order from an authorized health care practitioner. It may be within the scope of practice of the competent and appropriately trained licensed practical nurse to perform the following tasks related to a VAD or other infusion devices under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse:
- Short peripheral catheter line intraosseous access device, and subcutaneous infusion device insertion and removal;
- Preparing, initiating, managing, and monitoring infusion pumps;
- Peripheral (including short peripheral or midline), CVAD, arterial, umbilical arterial catheter (UAC) or umbilical venous catheter (UVC), intraspinal, intraosseous access device, and subcutaneous infusion device site monitoring, care, and dressing changes;
- Administration of infusion fluids and medications via peripheral, CVAD, and arterial catheters including through an implanted vascular access port, hemodialysis VAD, and UAC) or UVC;
- Medication administration via a VAD using piggyback, push, or bolus methods;
- Transfusion of blood products;
- Infusion of biologic therapies;
- Blood sampling via a peripheral, VAD, and arterial device;
- Administration of total parenteral nutrition;
- Monitor patency of the peripheral, CVAD, and arterial catheters;
- Change infusion sets; and
- Assist an authorized health care practitioner or registered nurse in removing or reinserting a CVAD or arterial catheter.
It is not within the scope of a licensed practical nurse to perform the following tasks:
- Independently insert or remove a CVAD, arterial catheter, or intraspinal catheter;
- Insert a peripherally inserted midline catheter.
The licensed practical nurse should use the Scope of Practice Decision Tree to determine if these activities are within the nurse's legal and individual scope of practice. The nurse must follow clinical standards of care. Examples include the Infusion Nurses Society (INS) and the National Infusion Center Association (NICA) practice, training, and competency standards for the licensed practical nurse.
- Complete an infusion therapy educational program, including supervised clinical practice on infusion therapy to document competency assessment and validation;
- Practice analysis for the licensed practical nurse including venipuncture for blood sampling and insertion and removal of peripheral catheters, maintenance of central vascular access devices (CVADs), and administration of IV medications by piggyback method; and
Perform infusion-related tasks under the supervision of a registered nurse or other authorized health care practitioner with appropriate infusion therapy knowledge and skills.