Chapter 4723-17 Intravenous Therapy Courses for Licensed Practical Nurses

For the purposes of this chapter, the following definitions shall apply:

(A) “Adult” means anyone who is eighteen years of age or older.

(B) “Direction” means communication of a plan of care, based upon assessment of the individual by the registered nurse, or licensed physician, dentist, optometrist or podiatrist which establishes the parameters for provision of care or for the performance of a procedure. Unless otherwise provided by law, the registered nurse or licensed physician, dentist, optometrist or podiatrist shall be available on site to assess and evaluate the individual’s response to the plan of care.

(C) “Initiate” means to start or to begin.

(D) “Maintain” means to administer or regulate an intravenous infusion according to the prescribed flow rate.

(E) “Piggyback” means an intermittent intravenous infusion.

(F) “OBN Approver” has the same meaning as in paragraph (J) of rule 4723-14-01 of the Administrative Code.

HISTORY: Eff 4-1-93; 12-1-93; 2-1-00; 2-1-05

Rule promulgated under: RC 119.03

Rule authorized by: RC 4723.07

Rule amplifies: RC 4723.01(F), 4723.17, 4723.171

R.C. 119.032 review dates: 10/15/2004 and 02/01/2010

A licensed practical nurse who seeks authorization from the board of nursing to perform intravenous therapy procedures in accordance with division (A) of section 4723.17 of the Revised Code and this chapter must have previously received board authorization to administer medications as provided in division (D) of section 4723.15 of the Revised Code.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Rule authorized by: RC 4723.07

Rule amplifies: RC 4723.17(A)

R.C. 119.032 review dates: 02/01/2010

(A) Except as provided in paragraph (B) of this rule, no licensed practical nurse shall perform any of the following intravenous therapy procedures:

(1) Initiate or maintain any of the following:

(a) Blood or blood components;

(b) Solutions for total parenteral nutrition;

(c) Cancer therapeutic medications including, but not limited to, cancer chemotherapy or an anti-neoplastic agents;

(d) Investigational or experimental medications;

(e) Solutions administered through any central venous line or arterial line or any other line that does not terminate in a peripheral vein, except as provided in paragraph (B)(1) of this rule;

(f) An intravenous piggyback infusion, except as provided in paragraph (B)(2) of this rule.

(2) Discontinue a central venous, arterial, or any other line that does not terminate in a peripheral vein;

(3) Initiate or discontinue a peripherally inserted central catheter;

(4) Aspirate any intravenous therapy line to maintain patency;

(5) Program or set any function of a patient controlled analgesic;

(6) Mix, prepare or reconstitute any medication for intravenous therapy, except as provided in paragraph (B)(3) of this rule;

(7) Administer medications by an intravenous route, except as provided in paragraph (B)(2) of this rule;

(8) Inject medications by a direct intravenous route, except as provided in paragraph (B)(4) of this rule;

(9) Change tubing on an arterial line, a central venous line, or on any line that does not terminate in a peripheral vein.

(B) A licensed practical nurse authorized by the board to perform intravenous therapy procedures, may perform the following procedures only for individuals aged eighteen or older and only when directed to do so by a licensed physician, dentist, optometrist, podiatrist, or registered nurse in accordance with section 4723.17 of the Revised Code:

(1) Administer through a central venous line or a peripherally inserted central catheter the following solutions only:

(a) An infusion containing one or more of the following elements:

(i) Dextrose 5%;

(ii) Normal saline;

(iii) Lactated ringers;

(iv) Sodium chloride 0.45%;

(v) Sodium chloride 0.2%; or

(vi) Sterile water;

(b) Subsequent containers of the intravenous therapy solutions specified in paragraph (B)(1)(a) of this rule that contain vitamins or electrolytes, provided a registered nurse initiated the infusion of that same intravenous solution.

(2) Initiate or maintain a peripheral intravenous piggyback infusion containing an antibiotic;

(3) Prepare or reconstitute only an antibiotic additive to be administered through a peripheral infusion;

(4) Inject heparin or normal saline to flush an intermittent infusion device or heparin lock, including, but not limited to, bolus or push;

(5) Change tubing on an intravenous line only if the line terminates in a peripheral vein;

(6) Initiate intravenous therapy only in the hand, forearm or antecubital space for the administration of solutions containing one or more of the following:

(a) An infusion containing one or more of the following elements:

(i) Dextrose 5%;

(ii) Normal saline;

(iii) Lactated ringers;

(iv) Sodium chloride 0.45%;

(v) Sodium chloride 0.2; or

(vi) Sterile water

(b) Subsequent containers of the intravenous therapy solutions specified in paragraph (B)(6)(a) of this rule that contain vitamins or electrolytes, provided a registered nurse initiated the infusion of that same intravenous solution.

(C) A licensed practical nurse authorized by the board to perform intravenous therapy procedures may perform the procedures set forth in paragraph (B) of this rule only if one of the following requirements are satisfied:

(1) Except as provided in paragraph (C)(3) of this rule, the licensed practical nurse is directed to perform intravenous therapy by a licensed physician, dentist, optometrist, or podiatrist who is present and readily available at the facility where the intravenous therapy procedure is performed;

(2) Except as provided in paragraph (C)(3) of this rule, the licensed practical nurse is directed to perform intravenous therapy by a registered nurse who has personally performed an on-site assessment of the individual to receive intravenous therapy, and that registered nurse or another registered nurse is readily available at the site where the intravenous therapy procedure is performed;

(3) When the intravenous therapy procedures are performed in a home as defined in section 3721.10 of the Revised Code, or in an intermediate care facility for the mentally retarded as defined in section 5111.20 of the Revised Code, a registered nurse who directs the authorized licensed practical nurse to perform intravenous therapy is either:

(a) On the premises of the home or facility; or

(b) Accessible by some form of telecommunication;

(D) Any licensed practical nurse may perform any of the intravenous therapy procedures specified in paragraph (E) of this rule on any person without receiving authorization to perform intravenous therapy from the board of nursing under section 4723.17 of the Revised Code, if both of the following apply:

(1) The licensed practical nurse acts at the direction of a registered nurse or a licensed physician, dentist, optometrist, or podiatrist and the registered nurse, physician, dentist, optometrist, or podiatrist is on the premises where the procedure is to be performed or accessible by some form of telecommunication; and

(2) The licensed practical nurse can demonstrate the knowledge, skills, and ability necessary to perform the procedure safely

(E) The intravenous therapy procedures that a licensed practical nurse may perform in accordance with paragraph (D) of this rule are limited to the following:

(1) Verification of the type of peripheral intravenous solution being administered;

(2) Examination of a peripheral infusion site and the extremity for possible infiltration;

(3) Regulation of a peripheral intravenous infusion according to the prescribed flow rate;

(4) Discontinuation of a peripheral intravenous device at the appropriate time; and

(5) Performance of routine dressing changes at the insertion site of a peripheral venous or arterial infusion, peripherally inserted central catheter infusion, or central venous pressure subclavian infusion.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Rule authorized by: RC 4723.07

Rule amplifies: RC 4723.01(F), 4723.17, 4723.171

119.032 Review Date: 02/01/2010

(A) Any person who desires to conduct a course in intravenous therapy for a licensed practical nurse shall submit the course individually for approval as a faculty-directed continuing education activity to an Ohio board of nursing (OBN) approver according to in accordance with Chapter 4723-14 of the Administrative Code.

(B) Approval of a course in intravenous therapy for licensed practical nurses may be withdrawn or denied by the OBN approver if the course fails to meet the minimum requirements of the board as set forth in this chapter and in Chapter 4723-14 of the Administrative Code.

(C) Each OBN approver shall publish and maintain a current list of approved courses in intravenous therapy for licensed practical nurses in Ohio. The board shall publish and maintain a current list of OBN approvers.

HISTORY: Eff 4/1/93, 2/1/00, 2/1/02; 4/1/93; 4/1/93; 2-1-05

Replaces: 4723-17-02, 4723-17-03, 4723-17-04

Rule promulgated under: RC 119.03

Rule authorized by: RC 4723.07

Rule amplifies: RC 4723.01(F), 4723.17

119.032 Review Date: 02/01/2010

(A) A person who is responsible for developing a licensed practical nurse intravenous therapy course for submission to an OBN approver shall satisfy all of the following:

(1) Hold an active Ohio license as a registered nurse;

(2) Possess a baccalaureate degree with a major in nursing;

(3) Have a minimum of two years experience in the practice of nursing as a registered nurse; and

(4) Have formal education or practical experience in adult education.

(B) Except as provided in paragraph (C) of this rule, the course in intravenous therapy for a licensed practical nurse shall be taught by one or more registered nurses each of whom meet the qualifications set forth in paragraphs (A)(1) to (A)(3) of this rule:

(1) Have completed an approved professional nursing education program;

(2) Hold an active Ohio license to practice nursing; and

(3) Have a minimum of two years experience in the practice of nursing as a registered nurse that includes substantial direct clinical experience in intravenous therapy.

(4) It is recommended that a registered nurse engaged in the teaching of licensed practical nurse intravenous therapy courses hold a baccalaureate degree with a major in nursing.

(C) A licensed health care professional who is not a registered nurse may be utilized to conduct a portion of the intravenous therapy course provided:

(1) The licensed health care professional teaches only a portion of the course at the direction of a registered nurse instructor; and

(2) The licensed health care professional imparts information that is consistent with his or her professional educational preparation and within his or her statutory scope of practice.

HISTORY: Eff 4-1-93; 2-1-00; 2-1-05

Replaces: 4723-17-05, 4723-17-06

Rule promulgated under: RC 119.03

Rule authorized by: RC 4723.07

Rule amplifies: RC 4723.17

R.C. 119.032 review dates: 02/01/2010

In accordance with division (A)(2)(a) of section 4723.17 of the Revised Code, the minimum curriculum for an intravenous therapy course for licensed practical nurses shall be that contained in administrative rules in effect on January 1, 1999, and restated in paragraphs (A)(1) to (A)(13), and paragraph (C) of this rule.

(A) A course which prepares licensed practical nurses in limited intravenous therapy shall include a minimum of forty hours of instruction which shall be distributed appropriately to include the list of components below. Time shall be allocated for laboratory and supervised clinical practice. The components shall include, but are not limited to the following:

(1) Policies and procedures of both the Ohio board of nursing and the employing agency relating to intravenous therapy and accountability and responsibility of the licensed practical nurse in the performance of limited intravenous therapy procedures;

(2) Support and psychological preparation for the individual receiving intravenous therapy as well as the appropriate family members and significant others;

(3) Anatomy and physiology of the peripheral veins used for venipuncture;

(4) Procedure for venipuncture, collection of equipment, site selection, palpation of veins, and skin preparation;

(5) Procedures for adding intravenous solutions to existing infusions, hanging intravenous solutions, changing intravenous tubing, performing intravenous dressing changes and flushing and converting peripheral intermittent infusion devices;

(6) Relationships between intravenous therapy and the body’s homeostatic and regulatory functions;

(7) Signs and symptoms of local and systemic complications in the administration of fluids and guidelines for management of these complications as well as preventive measures;

(8) Identification of various types of equipment used in administering intravenous therapy with content related to criteria for use of each and means of troubleshooting for malfunction;

(9) Formulas used to calculate flow rate;

(10) Principles and practices of universal precautions as related to intravenous therapy;

(11) Glossary of common terminology pertinent to intravenous therapy;

(12) Documentation of intravenous therapy procedures; and

(13) Demonstration of successful application of knowledge and skills to clinical practice by skills testing at least all of the components included in paragraphs (A)(8) and (A)(9) of this rule.

(B) In addition to the requirements set forth in paragraph (A) of this rule, an intravenous therapy course for licensed practical nurses shall also include the following:

(1) A review of Chapter 4723. of the Revised Code and the rules of the board with respect to the role, accountability, and responsibility of the licensed practical nurse in intravenous therapy;

(2) Anatomy and physiology of the cardiovascular system as related to homeostasis;

(3) Anatomy and physiology of the respiratory system as related to homeostasis;

(4) Signs and symptoms of local and systemic complications in the administration of antibiotics;

(5) Guidelines for the management of complications arising from the intravenous administration of antibiotics;

(6) Procedures for reconstituting and administering intravenous antibiotics via piggyback which shall include, but not be limited to, pharmacology, compatibilities, and flow rates;

(7) Procedures for maintaining a central line for infusing only the solutions specified in section 4723.17 of the Revised Code;

(8) A review of prohibited practices as set forth in section 4723.17 of the Revised Code; and

(9) A review of the role of the registered nurse, licensed physician, dentist, optometrist, or podiatrist who is directing the licensed practical nurse to perform an intravenous therapy procedure with reference to how the role may differ depending upon the setting in which the intravenous therapy is being provided.

(C) The registered nurse instructor of the course in limited intravenous therapy for licensed practical nurses shall plan and implement a minimum of at least three individually supervised successful venipunctures performed on clients in the healthcare setting, each of which includes the total implementation of intravenous therapy, by each student under the direct supervision of the registered nurse instructor. Opportunity shall be given to the nurses to develop proficiency in limited intravenous therapy procedures and related nursing care. Practice of all skill components and skills testing shall be done in either supervised clinical practice or while supervised in the laboratory.

(D) The performance of the three venipunctures required in paragraph (C) of this rule shall comprise no more than eight hours of the intravenous therapy course and shall be performed not later than six month after completing the didactic portion of the course. Supervision of the student venipunctures may be provided by either a registered nurse who is an instructor in the intravenous therapy course, or by a licensed physician.

Effective: 02/01/2008

R.C. 119.032 review dates: 10/01/2009

Promulgated Under: 119.03

Statutory Authority: RC 4723.07

Rule Amplifies: RC 4723.17

Prior Effective Dates: 4/1/93, 12/1/93, 2/1/00, 2/1/01, 2/1/05

(A) The provider of a board-approved course in intravenous therapy shall have specific policies in writing regarding the level of achievement that a licensed practical nurse must maintain in order to successfully complete the course in intravenous therapy and to obtain proof of completion of the course. Periodic evaluation of the nurse’s progress in the course shall be made by an instructor of the course.

(1) Each board-approved course shall include a testing component by which a licensed practical nurse can demonstrate competency related to intravenous therapy.

(2) Upon a student’s successful completion of an approved intravenous therapy course, the provider shall issue a certificate of successful completion.

(B) On a form provided by the board, each provider of a board-approved intravenous therapy course shall submit to the board, documentation of completion and the required twenty five dollar issuance fee for each licensed practical nurse who successfully completes the intravenous therapy program.

(C) Upon receiving satisfactory documentation that a licensed practical nurse has successfully completed a board-approved intravenous therapy course, the board shall approve such nurse as authorized to provide intravenous therapy and shall issue evidence of this authorization in a manner to be determined by the board.

(D) When a licensed practical nurse who has been licensed by endorsement in Ohio provides documentation satisfactory to the board of having successfully completed an intravenous therapy course in another state that substantially meets the requirements of this chapter, the board may approve such nurse as authorized to provide intravenous therapy and shall issue evidence of this authorization in a manner to be determined by the board. The board may condition issuance of evidence of this authorization on proof of the nurse’s successful completion of board-approved course content covering Chapter 4723. of the Revised Code and the rules of the board with respect to the role, accountability, and responsibility of the licensed practical nurse in intravenous therapy.

(E) No card, certificate or other documentation of board authorization to provide intravenous therapy shall be photocopied, reproduced, duplicated, or imaged onto paper or any electronic media. This prohibition shall not prohibit the nurse to whom such authorization is granted copying or otherwise reproducing such evidence of authorization provided that the copy or reproduction is immediately, clearly, and permanently labeled as a copy or reproduction, and such label is accompanied by the initials of the nurse.

HISTORY: Eff 4/1/93, 4/1/94, 2/1/00; 2-1-05

Replaces: 4723-17-08

Rule promulgated under: RC 119.03

Rule authorized by: RC 4723.07

Rule amplifies: RC 4723.17

119.032 Review Date: 02/01/2010

Nothing in this chapter shall prohibit a prelicensure practical nursing education program approved by the board from incorporating in its standard curriculum course work on intravenous therapy that meets the curriculum and other criteria set forth for licensed practical nurses in section 4723.17 of the Revised Code and this chapter.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Rule authorized by: RC 4723.07

Rule amplifies: RC 4723.17

R.C. 119.032 review dates: 02/01/2010

Nothing in this chapter shall prohibit a licensed practical nurse employed in a dialysis setting from completing an approved intravenous therapy course concurrently with the licensed practical nurse’s training in dialysis.

HISTORY: Eff 2-1-02; 2-1-05

Replaces: 4723-17-10

Rule promulgated under: RC 119.03

Rule authorized by: RC 4723.07

Rule amplifies: RC 4723.17

R.C. 119.032 review dates: 02/01/2010

Rescinded eff 2-1-05