Kentucky Administrative Regulations
Title 201 - GENERAL GOVERNMENT CABINET
Chapter 20 - Board of Nursing
Section 201 KAR 20:490 - Licensed practical nurse infusion therapy scope of practice
Universal Citation: 201 KY Admin Regs Service 20:490
Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO: KRS 314.011(10)(a), (c)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 314.131(1) authorizes the Board of Nursing to promulgate administrative regulations as may be necessary to enable it to carry into effect the provisions of KRS Chapter 314. KRS 314.011(10)(c) authorizes the board to promulgate an administrative regulation to establish the scope of practice for administering medicine or treatment by a licensed practical nurse. KRS 314.011(10)(a) requires that licensed practical nurses practice under the direction of a registered nurse, advanced practice registered nurse, physician assistant, licensed physician, or dentist. This administrative regulation establishes the scope of that practice as it relates to infusion therapy.
Section 1. Definitions.
(1)
"Administration" means to initiate and maintain infusion therapy.
(2) "Antineoplastic agent" means a medication
that prevents the development, growth, or proliferation of malignant
cells.
(3) "Central venous access
device" means a catheter inserted into a peripheral or centrally located vein
with the tip residing in the superior or inferior vena cava. This includes
peripherally inserted central catheters.
(4) "Direction" means a communication of a
plan of care that is based upon assessment of a patient by an advanced practice
registered nurse, a registered nurse, physician assistant, licensed physician,
or dentist that establishes the parameters for the provision of care or for the
performance of a procedure.
(5)
"Peripheral venous access device" means a peripherally-inserted intravenous
catheter or needle that is less than or equal to three (3) inches in
length.
(6) "Pharmacology" means
information on the classification of intravenous drugs, indications for use,
pharmacological properties, monitoring parameters, contraindications, dosing,
clinical mathematics, anticipated side effects, potential complications,
antidotal therapy, compatibilities, stabilities, specific considerations for
select intravenous drugs, and administration of intravenous medications to
pediatric, adult, and geriatric populations.
(7) "Procedural sedation" means the
administration of intravenous medications to produce a decreased level of
consciousness.
(8) "Supervision"
means the provision of guidance by a registered nurse, advanced practice
registered nurse, physician assistant, licensed physician, or dentist for the
accomplishment of a nursing task with periodic observation and evaluation of
the performance of the task including validation that the nursing task has been
performed in a safe manner.
(9)
"Supervisor" means the registered nurse, advanced practice registered nurse,
physician assistant, licensed physician, or dentist who provides supervision of
the licensed practical nurse's practice as defined in this section.
(10) "Therapeutic phlebotomy" means removal
of a specific volume of blood from a patient as ordered for the treatment of a
specific condition or disease.
(11)
"Unstable" means inconsistent, unpredictable, or consistently
fluctuating.
Section 2. Education and Training Standards.
(1) Prior to
performing infusion therapy, the licensed practical nurse (LPN) shall have
completed education and training related to the scope of infusion therapy for
an LPN. This education and training shall be obtained through:
(a) A prelicensure program of nursing for
individuals admitted to the program after September 15, 2019; or
(b) An institution, practice setting, or
continuing education provider that has in place a written instructional program
and a competency validation mechanism that includes a process for evaluation
and documentation of an LPN's demonstration of the knowledge, skills, and
abilities related to the safe administration of infusion therapy. The LPN shall
receive and maintain written documentation of completion of the instructional
program and competency validation.
(2) The education and training programs
recognized in subsection (1) of this section shall be based on the Policies and
Procedures for Infusion Therapy: Home Infusion and the Infusion Therapy:
Standards of Practice and shall include the following components:
(a) Legal considerations and risk management
issues;
(b) Related anatomy and
physiology including fluid and electrolyte balance;
(c) Principles of pharmacology as related to
infusion therapy;
(d) Infusion
equipment and preparation;
(e)
Principles and procedures for administration of solutions and medications via
intravenous route including transfusion therapy and parenteral
nutrition;
(f) Principles and
procedures for site maintenance for a peripheral venous access device and a
central venous access device;
(g)
Assessment of and appropriate interventions for complications related to
infusion therapy; and
(h)
Demonstration and validation of competency for infusion therapy
procedures.
Section 3. Supervision Requirements.
(1)
An LPN performing infusion therapy procedures shall be under the direction and
supervision of a registered nurse (RN), advanced practice registered nurse
(APRN), physician assistant, licensed physician, or dentist.
(2) For a patient whose condition is
determined by the LPN's supervisor to be stable and predictable, and rapid
change is not anticipated, the supervisor may provide supervision of the LPN's
provision of infusion therapy without being physically present in the immediate
vicinity of the LPN, but shall be readily available.
(3) In the following cases, for the LPN to
provide infusion therapy, the LPN's supervisor shall be physically present in
the immediate vicinity of the LPN and immediately available to intervene in the
care of the patient:
(a) If a patient's
condition is or becomes unstable;
(b) If a patient is receiving blood, blood
components, or plasma volume expanders; or
(c) If a patient is receiving peritoneal
dialysis or hemodialysis.
Section 4. Standards of Practice.
(1) An LPN shall perform only those infusion
therapy acts for which the LPN possesses the knowledge, skill, and ability to
perform in a safe manner, except as limited by Section 5 of this administrative
regulation and under supervision as required by Section 3 of this
administrative regulation.
(2) An
LPN shall consult with an RN or physician, physician assistant, dentist, or
advanced practice registered nurse and seek guidance as needed if:
(a) The patient's care needs exceed the
licensed practical nursing scope of practice;
(b) The patient's care needs surpass the
LPN's knowledge, skill, or ability; or
(c) The patient's condition becomes
unstable.
(3) An LPN
shall obtain instruction and supervision as necessary if implementing new or
unfamiliar nursing practices or procedures.
(4) An LPN shall follow the written,
established policies and procedures of the facility that are consistent with
KRS Chapter 314.
Section 5. Functions That Shall Not Be Performed. An LPN shall not perform the following infusion therapy functions:
(1)
Administration of tissue plasminogen activators, except when used to declot any
central venous access device;
(2)
Accessing of a central venous access device used for hemodynamic
monitoring;
(3) Administration of
medications or fluids via arterial lines or implanted arterial ports;
(4) Accessing or programming an implanted
infusion pump;
(5) Administration
of infusion therapy medications for the purpose of procedural sedation or
anesthesia;
(6) Administration of
fluids or medications via an epidural, intrathecal, intraosseous, or umbilical
route, or via a ventricular reservoir;
(7) Administration of medications or fluids
via an arteriovenous fistula or graft, except for dialysis;
(8) Repair of a central venous access
device;
(9) Performance of
therapeutic phlebotomy;
(10)
Aspiration of an arterial line;
(11) Initiation and removal of a peripherally
inserted central, midclavicular, or midline catheter; or
(12) Administration of immunoglobulins,
antineoplastic agents, or investigational drugs.
Section 6. Incorporation by Reference.
(1) The following material is incorporated by
reference:
(a) "Policies and Procedures for
Infusion Therapy: Home Infusion", Infusion Nurses Society, Second Edition,
2021; and
(b) "Infusion Therapy:
Standards of Practice", Infusion Nurses Society, Eighth Edition,
2021.
(2) This material
may be inspected, copied, or obtained, subject to applicable copyright law, at
the Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky,
Monday through Friday, 8 a.m. to 4:30 p.m. Links to this material is also
available on the board's Web site at
https://kbn.ky.gov/General/Pages/Document-Library.aspx .
STATUTORY AUTHORITY: KRS 314.011(10)(c), 314.131(1)
The amended version of this section by; eff. 11/21/2023 is not yet available.
Disclaimer: These regulations may not be the most recent version. Kentucky may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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