The nursing laws and rules allow the competent and appropriately trained registered nurse from performing infusion therapy. Invasive procedures require an order from an authorized health care practitioner. It may be within the scope of practice of a registered nurse to perform the following tasks related to a VAD or other infusion devices under the direction of an authorized health care practitioner:
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 insertion or removal, site monitoring, care, and dressing changes;
- Insertion or removal, 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, including stem cell therapies;
- Blood sampling via a peripheral, VAD, and arterial device;
- Administration of total parenteral nutrition;
- Monitor patency of the peripheral, CVAD, and arterial catheters; and
- Change infusion sets.
The registered 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 registered nurse.