Chapter 4723-17 Intravenous Therapy Courses for Licensed Practical Nurses

4723-17-01 Definitions.

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

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

(B) "Antibiotic" means a medication, including an anti-infective or anti-fungal, administered to inhibit the growth of, or destroy, microorganisms in the treatment or prevention of infectious disease.

(C) "Direction" means communication of a plan of care, based upon assessment of the client by the registered nurse, or licensed physician, dentist, optometrist, or podiatrist, that establishes the parameters for providing care or performing 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 client's response to the plan of care.

(D) "Initiate" means to start or to begin.

(E) "Maintain" means to administer or regulate an intravenous infusion according to the prescribed flow rate.

(F) "Piggyback" means an intermittent or secondary intravenous infusion.

(G) "OBN Approver" has the same meaning as in paragraph (I) of rule 4723-14-01 of the Administrative Code.

Effective: 02/01/2010
R.C. 119.032 review dates: 10/13/2009 and 10/01/2014
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01(F) , 4723.17 , 4723.171
Prior Effective Dates: 4/1/93, 12/1/93, 2/1/2000, 2/1/2005

4723-17-02 [Rescinded] LPN eligibility.

Effective: 02/01/2010
R.C. 119.032 review dates: 10/13/2009
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.17
Prior Effective Dates: 02/01/2005

4723-17-03 Intravenous therapy procedures.

(A) Except as provided in paragraph (B) of this rule, a licensed practical nurse shall not 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)(3) 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, or any catheter that is longer than three inches;

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

(5) Mix, prepare or reconstitute any medication for intravenous therapy, except as provided in paragraph (B)(4) of this rule;

(6) Administer medications by an intravenous route, except as provided in paragraph (B)(3) of this rule;

(7) Inject medications by a direct intravenous route, except as provided in paragraph (B)(5) of this rule;

(8) 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 the following solutions through a venous line:

(a) 5 per cent dextrose and water;

(b) 5 per cent dextrose and lactated ringers;

(c) 5 per cent dextrose and normal saline;

(d) Normal saline;

(e) Lactated ringers;

(f) 0.45 per cent sodium chloride and water;

(g) 0.2 per cent sodium chloride and water; or

(h) 0.3 per cent sodium chloride and water.

(2) Administer any of the solutions set forth in paragraph (B)(1) of this rule that contain vitamins or electrolytes after a registered nurse initiates the first infusion of the solution containing vitamins or electrolytes.

(3) Initiate or maintain an intermittent or secondary intravenous infusion containing an antibiotic;

(4) Prepare or reconstitute an antibiotic additive to be administered through an intravenous infusion;

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

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

(7) Place a venous access catheter, no longer than three inches in length, in the hand, forearm or antecubital space, followed by the placement of a saline or heparin lock, either for purposes of intermittent infusions, or to initiate infusions of any of the solutions set forth in paragraph (B)(1) of this rule; or

(8) Stop an infusion of blood or blood component, or turn off the function of a patient-controlled analgesic device when a complication arises.

(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 met:

(1) 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) 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; or

(3) If 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) A licensed practical nurse may perform any of the intravenous therapy procedures specified in paragraph (E) of this rule 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.

Effective: 02/01/2014
R.C. 119.032 review dates: 10/15/2014
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01(F) , 4723.18 , 4723.181
Prior Effective Dates: 02/01/2005, 02/01/2010

4723-17-04 [Rescinded] Approval of an intravenous therapy course.

(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 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.

Effective: 02/01/2010
R.C. 119.032 review dates: 10/13/2009
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01(F) , 4723.17
Prior Effective Dates: 04/01/1993, 02/01/2000, 02/01/2002, 02/01/2005

4723-17-05 Standards for intravenous therapy continuing education course personnel.

(A) An application for approval of a faculty-directed continuing education intravenous therapy course must demonstrate that the person submitting the continuing education course for approval:

(1) Holds a current, valid Ohio license as a registered nurse;

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

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

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

(B) Except as provided in paragraph (C) of this rule, the minimum faculty qualifications for teaching a continuing education course in intravenous therapy for a licensed practical nurse are:

(1) Completion of a board-approved registered nursing education program, or a registered nursing education program approved by another national council of state boards of nursing jurisdiction;

(2) A current, valid Ohio license to practice nursing as a registered nurse; and

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

(C) A licensed health care professional who is not a registered nurse may teach a portion of the intravenous therapy continuing education course provided:

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

(2) The licensed health care professional teaches information that is consistent with the professional's educational preparation and licensed scope of practice.

Replaces: replaces former 4723-17-05

Effective: 02/01/2010
R.C. 119.032 review dates: 10/01/2014
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.17
Prior Effective Dates: 04/01/1993, 02/01/2000, 02/01/2005

4723-17-06 Minimum curriculum requirements.

According to 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 that prepares licensed practical nurses in limited intravenous therapy shall include a minimum of forty hours of instruction that 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 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 blood and body fluid precautions, as set forth in Chapter 4723-20 of the Administrative Code, and 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) 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.

Effective: 02/01/2010
R.C. 119.032 review dates: 10/13/2009 and 10/01/2014
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.17
Prior Effective Dates: 04/01/1993, 12/01/1993, 02/01/2000, 02/01/2001,
02/01/2005, 02/01/2008

4723-17-07 Proof of completion of an approved course in intravenous therapy.

(A) In order to be approved or reapproved as a faculty-directed intravenous therapy continuing educational activity, in addition to the requirements contained in Chapter 4723-14 of the Administrative Code, an applicant for approval, or a provider seeking re-approval, shall have and implement written policies addressing the following:

(1) The level of achievement that a nurse must maintain in order to successfully complete the course in intravenous therapy and to obtain proof of completion of the course;

(2) Periodic evaluation of the nurse's progress in the course by an instructor of the course;

(3) A testing component that measures a nurse's competency related to intravenous therapy;

(4) A process for issuing a certificate of completion to nurses who have successfully completed the approved intravenous therapy course; and

(5) Submission to the board, on a form provided by the board, of documentation of each nurse's completion of the approved intravenous therapy course.

(B) Upon receiving satisfactory documentation that a licensed practical nurse has successfully complete an approved intravenous therapy course, the board shall approve such nurse as authorized to provide intravenous therapy.

(C) 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. The board may require, prior to approval, that the nurse successfully complete a continuing education activity that includes course content covering Chapter 4723. of the Revised Code, and the rules of the board related to the role, accountability and responsibility of the licensed practical nurse in intravenous therapy.

Replaces: replaces former 4723-17-07

Effective: 02/01/2010
R.C. 119.032 review dates: 10/01/2014
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.17
Prior Effective Dates: 04/01/1993, 04/01/1994, 02/01/2000, 02/01/2005

4723-17-08 [Rescinded] Training as part of a practical nursing program.

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.

Effective: 02/01/2010
R.C. 119.032 review dates: 10/13/2009
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.17
Prior Effective Dates: 02/01/2005

4723-17-09 [Rescinded] Training in intravenous therapy in conjunction with dialysis training.

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.

Effective: 02/01/2010
R.C. 119.032 review dates: 10/13/2009
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.17
Prior Effective Dates: 02/01/2002, 02/01/2005

4723-17-10 Training in intravenous therapy in conjunction with dialysis training. [Rescinded].

Rescinded eff 2-1-05