(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;
(9) Change an intermittent infusion device, unless the tip of the connected intravenous catheter terminates 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 4723.18 of the Revised Code:
(1) Administer the following solutions, or combinations of the solutions, through a venous line:
(a) five per cent dextrose and water;
(b) five per cent dextrose and lactated ringers;
(c) five 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 intermittent infusion device and on an intravenous line 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 individuals with intellectual disabilities as defined in section 5124.01 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 4723.18 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.
Five Year Review (FYR) Dates: 10/15/2014 and 10/15/2019
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, 02/01/2014