Md. Code Regs. 10.27.20.05

Current through Register Vol. 51, No. 12, June 14, 2024

Section 10.27.20.05 - Infusion Therapy Acts - LPN

A. The LPN may perform the following infusion therapy acts for peripheral and subcutaneous infusions when there is an RN on site or available by telephone:

(1) Calculate and adjust flow rate including pumps;

(2) Observe and report on:

(a) Insertion site, and

(b) Objective and subjective signs of adverse reactions to infusion therapy;

(3) Change the dressing on the insertion site;

(4) Change the administration set;

(5) Insert subcutaneous needle or catheter to:

(a) Rotate sites for an existing infusion, and

(b) Administer a medication which is routine for the patient;

(6) Insert a peripheral IV needle or catheter (excluding midline) to:

(a) Withdraw a blood specimen, or

(b) Initiate IV fluids;

(7) Remove a peripheral and subcutaneous IV needle or catheter;

(8) Flush a peripheral and midline IV device;

(9) Convert an existing continuous infusion to an intermittent infusion;

(10) Convert an intermittent infusion to a continuous infusion;

(11) Change injection cap;

(12) Insert device and initiate hypodermoclysis and add replacement solutions; and

(13) Administer medication via a peripheral IV line (including midline) using:

(a) Pharmacy-prepared medication, and

(b) PPN solutions; and

(14) Add medications to an intravenous solution.

B. The LPN may perform the following acts for midclavicular, CVC, PICC, and implanted ports:

(1) Calculate and adjust flow rate including a pump;

(2) Observe and report on:

(a) The insertion site, and

(b) Objective and subjective signs of adverse reactions to infusion therapy;

(3) Change the dressing on the insertion site;

(4) Flush a midclavicular, PICC, CVC, and an accessed implanted port;

(5) Change injection cap;

(6) Change administration sets;

(7) Convert an existing continuous infusion to an intermittent infusion; and

(8) Convert an intermittent infusion to a continuous infusion.

C. The LPN may perform the following additional acts under the direct supervision of the RN following a comprehensive patient assessment:

(1) Administer TPN via PICC, implanted ports, or CVC;

(2) Administer medications by midclavicular, PICC, CVC, and implanted ports by hanging pharmacy prepared solutions;

(3) Add medication to a solution administered via PICC, midclavicular CVC, and implanted ports;

(4) Observe, monitor, and report on the patient:

(a) With specialized catheters; and

(b) During a blood transfusion;

(5) Initiate and administer blood and blood components;

(6) Draw blood specimens via midline, PICC, CVC, and implanted ports;

(7) Access and de-access implanted ports; and

(8) Initiate the first dose of a medication after it has been reviewed and evaluated for potential risk by the RN.

D. On completion of a second specialized educational program in infusion therapy, containing didactic content and a clinical practicum, consistent with the standards of ONS or other bodies approved by the Board and with documented evidence of clinical competency, the LPN may administer standardized doses of non-vesicant chemotherapeutic agents and antiviral agents to an existing infusion in accord with the facility's written protocol or practice guidelines. The LPN shall perform these additional procedures under the direct supervision of the RN following a comprehensive patient assessment.

E. The LPN may perform additional infusion therapy acts in a licensed outpatient dialysis facility serving the chronic dialysis client when:

(1) The requirements of Regulations .03 and .04 of this chapter and §§A-C of this regulation have been met;

(2) The outpatient dialysis unit RN skilled in chronic dialysis has taught a didactic and clinical practicum for the LPN which includes but is not limited to:

(a) Pharmacological interventions specific to:

(i) Physiological alterations and effects of chronic renal failure;

(ii) Indication, dosage, side effects, and contraindications of each drug intervention; and

(iii) Special considerations of each drug intervention specific to the chronic renal failure client; and

(b) Route of medication administration and access delivery systems;

(3) The outpatient dialysis RN documents evidence of the LPN's clinical competency of the additional activities under §F of this regulation.

F. The LPN may perform the following additional infusion acts, that may include the flushing of catheters, in a licensed outpatient dialysis facility serving the chronic dialysis client under the direct supervision of the RN skilled in chronic dialysis:

(1) Venipuncture for the purpose of hemodialysis;

(2) Initiation of and discontinuation from dialysis utilizing the various accesses, including:

(a) Subclavian catheters;

(b) Internal jugular catheters;

(c) Femoral vein catheters;

(d) Arterial catheters;

(e) Fistulas; and

(f) Grafts;

(3) Withdrawal of blood and heparinized saline from the various accesses for the purpose of removing the heparin and establishing patency;

(4) Withdrawal of blood from access for the purpose of obtaining blood for a laboratory specimen;

(5) Administration of IV medications and solutions during hemodialysis;

(6) Performance of dressing changes to various access device sites; and

(7) Administration of the following medications by IV "push" per physician order and nationally recognized standards of care:

(a) Anticoagulant agents;

(b) Saline;

(c) Erythropoeitic agents;

(d) Vitamin D products;

(e) Iron preparation agents; and

(f) Anti-emetic agents.

G. The LPN may not perform the following acts:

(1) Administer medication via IV "push", except as set forth in §F(7) of this regulation;

(2) Insert a midline catheter;

(3) De-clot the catheter;

(4) Repair a catheter;

(5) Insert and remove PICC, midline catheters, and midclavicular catheters;

(6) Manage specialized catheters for analgesia; and

(7) Remove nonsurgically placed central and arterial catheters.

Md. Code Regs. 10.27.20.05

Regulations .05 adopted effective November 15, 1999 (26:23 Md. R. 1777)
Regulation .05 amended effective October 27, 2003 (30:21 Md. R. 1529)