Current through Register Vol. 43, No. 02, November 27, 2024
(1) A licensed facility may develop a
standardized procedure, as defined in Rule
610-X-6-.12, for intravenous (IV)
therapy by a licensed practical nurse.
(2) The minimum requirements for a licensed
practical nurse to perform IV therapy includes successful completion of an
organized program of study, supervised clinical practice, and demonstrated
clinical competence, initially and at periodic intervals, according to the
requirements of Rule
610-X-6-.12.
(3) The minimum training for the licensed
practical nurse who performs selected tasks associated with IV therapy shall
include:
(a) Anatomy and physiology.
(b) Fluid and electrolyte balance.
(c) Equipment and procedures utilized in
intravenous therapy.
(d)
Complications, prevention, and nursing intervention.
(e) Introducing a peripheral intravenous
device on an adult patient.
(f)
Set-up, replacement, and removal of intravenous tubing for gravity flow and/or
pump infusion.
(g) Intravenous
fluid infusion calculations and adjustment of flow rates on intravenous fluids
and administration of intravenous medications by piggyback.
(h) Procedures for reconstituting and
administering intravenous medications via piggyback, including but not limited
to pharmacology, compatibilities, and flow rates.
(4) Medications may be administered by
licensed practical nurses through a peripheral intravenous catheter by
intravenous push, provided the following criteria are met:
(a) A complete standardized procedure
application is submitted and approved by the Board prior to
implementation.
(b) The
medication(s) does not require the substantial skill, judgment, and knowledge
of a registered nurse.
(c) On-site
supervision by a registered nurse any time an IV push medication therapy is
performed by a licensed practical nurse.
1.
The registered nurse is required to be physically present and immediately
available in the facility.
2.
Heparin (10 units: 1 ml) flush or saline flush via a peripheral IV line is not
a medication within the meaning of these rules.
(d) Medications that may be administered by
peripheral IV push by a licensed practical nurse, if identified in the licensed
hospital's standardized procedure include, but are not limited to the
following:
5. Fifty percent (50%) dextrose in an
emergency situation.
(5) The minimum training for the licensed
practical nurse who performs selected tasks associated with IV push therapy
shall include:
(a) Pharmacology of specific
drugs and reversal agents, if applicable, including but not limited to:
5. Contraindications and
precautions.
7. Antidote, if
applicable.
8. Nursing
considerations and implications.
(b) Procedure for reconstituting medications
including compatibilities.
(c)
Technique of medication administration by IV push.
(6) Tasks that shall not be performed by a
licensed practical nurse include:
(a)
Initiation of intravenous therapy in a neonate.
(b) Administration of:
1. Solutions requiring titration. Solutions,
such as heparin drips, that require changes based on lab results subject to
written orders or protocol, are not solutions requiring titration for purposes
of these rules.
2. Plasma volume
expanders.
3. Fibrinolytic or
thrombolytic agents.
4.
GP-II-B-III-A inhibitors, also known as plateletaggregate inhibitors.
5. Hyperalimentation administered by routes
other than peripheral intravenous catheter.
6. IV medications for the purposes of
moderate sedation or anesthesia.
7.
IV medications via push or bolus through a central line including a
peripherally inserted central catheter (PICC). This prohibition shall not apply
to stable patients with a PICC or midline catheter in a home health setting,
long term care, skilled nursing facility, acute care facility, hospice, or a
Hospital At Home Program with an approved standardized procedure, as provided
in §
610-X-6-.12. Not withstanding any
other provision of this rule, indirect supervision by a registered nurse shall
be sufficient for LPNs practicing as provided in this subsection.
8. IV push insulin or chemotherapeutic
agents. This does not preclude hanging a pre-mixed bag of fluids containing
additives, except for insulin and chemotherapeutic agents.
9. Any other drugs deemed to be inappropriate
by the licensed hospital's standardized procedure.
(c) Accessing or programming an implanted IV
infusion pump.
(d) Performance of
the repair of a central venous route access device.
(e) Performance of therapeutic
phlebotomy.
(f) Direct access of a
central venous route access device, including but not limited to:
1. Implanted ports for intravenous
therapy.
2. Lines used for
hemodynamic monitoring.
3. Central
venous catheters and devices, including Groshong catheters, Hickman catheters,
and peripherally inserted central catheters (PICC). These rules do not prohibit
licensed practical nurses from administering medications via piggyback or in
secondary solutions via central lines.
(7) Each facility in which licensed practical
nurses will perform selected tasks associated with administration of blood and
blood components shall have an approved standardized procedure on file with the
Board, prior to implementation. The minimum training for those licensed
practical nurses who perform selected tasks associated with administration of
blood and blood components shall include:
(a)
Anatomy and physiology.
(b) Fluid
and electrolyte balance.
(c)
Equipment and procedures utilized in blood and blood components administration
therapy.
(d) Complications,
prevention, and nursing intervention.
Rule .11 was renumbered .14 as per certification filed
November 23, 2009; effective December 28,
2009.
Author: Alabama Board of Nursing
Statutory Authority:
Code of Ala.
1975, §
34-21-2(c)(21).
