Ohio — Edition 36
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LPN IV Therapy

The Board frequently receives inquiries concerning the authorized practices of the IV therapy-certified licensed practical nurse (LPN-IV). For example, questions have been presented regarding the types of catheters through which IV therapy may be administered by the LPN-IV, specifically catheters that terminate in a peripheral vein in the upper arm, clinically known as a “midline” catheter, and those that are inserted peripherally but terminate in a central vein clinically referred to as a peripherally inserted central catheter or PICC line.

Chapter 4723-17, Ohio Administrative Code (OAC), makes a distinction in the IV therapy procedures that may be performed by a LPN-IV based on whether or not the intravenous line “does” or does not” terminate in a peripheral vein. Peripherally inserted central catheters (PICCs) terminate in a central vein and not in a peripheral vein. The administrative rules prohibit a LPN from inserting a venous access catheter that is greater than three inches in length In the hand, forearm or antecubital space. The term “midline” catheter is not defined in rule, but the criteria to consider is whether or not the catheter itself terminates in a peripheral vein or not. Veins located in the upper arm above the antecubital space and below the shoulder are anatomically categorized as “peripheral.”

The regulations pertaining to performance of IV therapy are located in Section 4723.17, of the Ohio Revised Code (ORC), and Chapter 4723-17, OAC. These regulations can be accessed on the Board’s website: www.nursing.ohio.gov under the “Law and Rules” link.

Question: Can the LPN-IV infuse normal saline and lactated ringers through a midline or PICC line?

Answer: Yes. According to Rule 4723-17-03(B)(1), OAC, a LPN-IV may administer the following solutions through a ”venous line,” or through catheters that terminate in either a peripheral or central vein, as long as the patient is age 18 years of age or older and the LPN is directed to perform the IV therapy by a registered nurse, physician, dentist, podiatrist, or optometrist, who establishes the further parameters for providing care or performing the IV therapy procedure:

5% dextrose and water

5% dextrose and lactated ringers

5% dextrose and normal saline Normal saline Lactated Ringers

0. 45% sodium chloride and water or 0. 2% sodium chloride and water

Question: Can a LPN administer an antibiotic through a midline catheter?

Answer: Yes, if the LPN is directed to do so for a specific patient, as discussed in the response to the previous question.The LPN is not prohibited from administering an IV through a catheter that terminates in a peripheral vein.

A LPN-IV may initiate or maintain a peripheral intermittent or secondary intravenous infusion containing an antibiotic. The permissive language is contained in Section 4723.17 (D)(6)(b), ORC, and rule 4723-17-03 (B)(3), OAC. A LPN may administer an antibiotic via intermittent or secondary infusion through a catheter that terminates in a peripheral vein in the upper arm.

Question: What about administering an antibiotic through a PICC line?

Answer: No. The same rule discussed above mentions only a peripheral infusion pertaining to antibiotics and does not permit the LPN-IV to administer an antibiotic through a line that terminates in a central vein. The LPN-IV is not authorized to administer an antibiotic through a PICC line.

Question: Can a LPN flush a midline or PICC line with heparin or normal saline?

Answer: A LPN-IV, with the direction of a registered nurse or a physician, dentist, podiatrist, or optometrist may inject only heparin or normal saline to flush an intermittent infusion device, or heparin lock, for lines that are being used intermittently.This permissive language is contained in Section 4723.17(D)(6)(c) , ORC, and Rule 4723-17-03(B)(5), OAC. The LPN may flush a venous line with heparin or normal saline if it has an intermittent infusion device.

Section 4723.17, ORC, and Chapter 4723-17, OAC, are available for review on the Board’s website at: www.nursing.ohio.gov under the “Law and Rules” link. The LPN IV regulations discussed above must be applied in conjunction with the Standards of Practice Relative to Registered Nurse or Licensed Practical Nurse contained in Chapter 4723-4, OAC.
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