Texas Board of Nursing

http://www.bne.state.tx.us/

Pedagogy Recommendations:

LVN’s:

A baseline education of Basics of Peripheral IV therapy in Adults and Current Practices in the Management of Central Lines. For those nurses that practice in settings where advanced infusions or techniques are allowed by facility policy. You are required to obtain education for those infusions and techniques, as well.  For example if you practice in a facility that allows the LVN to administer Total Parenteral Nutrition (TPN), you should complete TPN administration continuing education. Skills competency validations are completed as required by the employer.

RN’s:

All courses may be used as a refresher and to fulfill continuing education requirements for licensed renewals. The Infusion Nurse Society now also recommends all RN’s successfully complete an organized education program on infusion therapy derived from the application of the Infusion Nursing Standards of Practice. All of Pedagogy Inc.’s infusion courses meet the INS Standards of Practice.

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Boards of Nursing often change mandates, rules and regulations. Please follow the links below to ensure the following requirements are current.


15.3 LVNs Engaging in Intravenous Therapy, Venipuncture, or PICC Lines
Copied from Texas Board of Nurse Examiners;above link.

15.3 LVNs Engaging in Intravenous Therapy, Venipuncture, or PICC Lines

The basic educational curriculum for Licensed Vocational Nurses (LVNs) does not mandate teaching of principles and techniques of insertion for peripheral intravenous catheters, or the administration of fluids and medications via the intravenous route. Knowledge and skills relating to maintaining patency and performing dressing changes of central line intravenous catheters is also not mandated as part of basic LVN education. As such, basic competency in management of intravenous lines/intravenous therapy is not a given for any specific LVN licensee.

Applicable Nursing Standards
LVN practice is guided by the Nursing Practice Act (NPA) and Board Rules. Rule 217.11, Standards of Nursing Practice, is the rule most often applied to nursing practice issues. Two standards applicable in all practice scenarios include:
  • 217.11(1)(B) implement measures to promote a safe environment for clients and others, and
  • 217.11(1)(T) accept only those assignments that take into consideration client safety and that are commensurate with the nurse's educational preparation, experience, knowledge, and physical and emotional ability.
Additional standards in Rule 217.11 that may be applicable when a LVN chooses to engage in an IV therapy-related task include (but are not limited to):
  • (1)(C) Know the rationale for and effects of medications and treatments and shall correctly administer the same,
  • (1)(D)Accurately and completely report and document: (i) ..client status....(ii) nursing care rendered...(iii) physician, dentist or podiatrist orders...(iv) administration of medications and treatments....(v) client response(s)...,
  • (1)(G) Obtain instruction and supervision as necessary when implementing nursing procedures or practices,
  • (1)(H) Make a reasonable effort to obtain orientation/training for competency when encountering new equipment and technology or unfamiliar care situations,
  • (1)(R) Be responsible for one's own continuing competence in nursing practice and individual professional growth,
  • (2)(A) Shall utilize a systematic approach to provide individualized, goal-directed nursing care ...[(i)-(v)], and
  • (2)(C) ...perform other acts that require education and training as prescribed by board rules and policies, commensurate with the LVN's experience, continuing education, and demonstrated LVN competencies.
Position Statement 15.27, The Licensed Vocational Nurse Scope of Practice provides additional clarification of the Standards Rule as it applies to LVN Scope of Practice. Instruction and skill evaluation relating to LVNs performing insertion of peripheral IV catheters and/or administering IV fluids and medications as prescribed by an authorized practitioner may allow a LVN to expand his/her scope of practice to include intravenous therapy.

It is the opinion of the Board that the LVN shall not engage in IV therapy related to either peripheral or central venous catheters, including venipuncture, administration of IV fluids, and/or administration of IV push medications, until successful completion of a validation course that instructs the LVN in the knowledge and skills applicable to the LVN's IV therapy practice. The BON does not define or set qualifications for an "IV Validation Course" or for "LVN IV certification." The LVN who chooses to engage in intravenous therapy must first have been instructed in the principles of intravenous therapy congruent with prevailing nursing practice standards.

Insertion of PICC Lines
The Board has further determined that the one-year vocational nursing program does not provide the Licensed Vocational Nurse (LVN) with the educational foundation to assure client safety in insertion of Peripherally Inserted Central Catheters (PICC lines) inclusive of vein selection, insertion/advancement of the catheter, determining placement, and monitoring of the client for untoward reactions in relation to catheter insertion. Position Statement 15.27, The Licensed Vocational Nurse Scope of Practice, further maintains that continuing education that falls short of achieving licensure as a registered nurse would be insufficient to assure vocational nurse competency and patient safety with regard to insertion of PICC lines. Therefore, it is the Board's position that insertion of PICC lines is beyond the scope of practice for LVNs.

Administration of IV Fluids and Medications
The ability of a LVN to administer specific IV fluids or drugs, to prepare and/or administer IV "piggy-back" or IV "push" medications, or to monitor and titrate "IV drip" medications of any kind is up to facility policy. The LVN's practice relative to IV therapy must also comply with any other regulations that may exist under the jurisdiction of other regulatory agencies or entities. The LVN who accepts an assignment to engage in any aspect of intravenous therapy is responsible for adhering to the NPA and Board rules, particularly §217.11 Standards of Nursing Practice, including excerpted standards listed above and any other standards or rules applicable to the individual LVN's practice.

All nursing actions related to peripheral and/or central intravenous lines, as well as IV administration of medications, must be completed in accordance with the orders of the prescribing practitioner, as well as written policies, procedures and job descriptions approved by the health care employer.

(Board Action: 06/1995; Revised 09/1999; 01/2005; 01/2011; 01/2012)
(Reviewed - 01/2006; 01/2007; 01/2008; 01/2009; 01/2010)

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