Title: Infusion Therapy
(formerly entitled Intravenous Therapy)
Advisory Ruling Number: 9204
The Massachusetts Board of Registration in Nursing (Board) issues this Advisory Ruling on Nursing practice pursuant to Massachusetts General Laws ("G.L."), chapter 30A, section 8 and chapter 112, section 80B.
Date Issued: April 23, 1992
Date Revised: July 10, 2002, March 14, 2007, September 12, 2012
Scope of Practice:
Registered Nurse and Licensed Practical Nurse for Infusion Therapy
Registered Nurse for Intra-osseous Device Insertion and Removal
To guide the practice of the Registered Nurse and Licensed Practical Nurse ("the licensed nurse") who as part of their nursing practice may perform infusion therapy through vascular or intra-osseous access.
Such practice must be in compliance M.G.L. c. 112, s. 80B, 244 CMR 3.02 Responsibilities and Functions – Registered Nurse; 244 CMR 3.04 Responsibilities and Functions – Practical Nurse; 244 CMR 9.03(5) Adherence to Standards of Nursing Practice; 244 CMR 9.03 (8) Identification Badge; 244 CMR 9.03(9) Responsibility and Accountability; 244 CMR 9.03 (10) Acts within the Scope of Practice; 244 CMR 9.03 (11) Performance of Techniques and Procedures; 244 CMR 9.03 (12) Competency; 244 CMR 9.03 (14) Asepsis and Infection Control; 244 CMR 9.03(35) Security of Controlled Substances; 244 CMR 9.03(38) Administration of Drugs; 244 CMR 9.03(39) Documentation of Controlled Substances; 244 CMR 9.03(44) Documentation; and 244 CMR 9.03(46) Responsibilities of Nurse in Management Role.
Registered Nurse practice may include: peripheral intravenous device insertion and removal; use of adjunct aids such as ultrasound for vein identification and selection, intra-osseous device insertion using manual, impact-driven or powered drill technique; intra-osseous device removal; use of an existing intravenous or other infusion device for the administration of medication, hydration, nutrition, blood products, or obtaining a blood sample; monitoring the patient; and maintenance of the infusion site.
Licensed Practical Nurse practice may include: peripheral intravenous device insertion and removal; use of adjunct aids such as ultrasound for vein identification and selection; use of an existing intravenous or other infusion device for the administration of medication, hydration, nutrition, blood products, or obtaining a blood sample; monitoring the patient; and maintenance of the infusion site.
Infusion therapy may be performed by licensed nurses only under the following requirements.
The licensed nurse must:
- Assume only those responsibilities for which he/she has education, experience and clinical competency to perform, and which are in compliance with established institutional/agency policy and procedures.
- Possess initial and ongoing competence related to the following as evidenced by documented completion of continuing education programs, employing agency education programs, and/or certification:
- Patient assessment;
- Site selection;
- Device placement;
- Site care and maintenance;
- Infusion equipment and add-on devices;
- Infection control, safe handling and hazardous materials;
- Fluid, electrolyte and medication administration; and
- Indications, contraindications and complications.
- Possess initial and ongoing competence when incorporating the use of adjunct aids such as ultrasound for vein identification and selection, as evidenced by documented completion of continuing education programs, employing agency education programs, and/or certification;
- Ensure documentation is complete, accurate and legible in all records required by federal and state law; and
- Administer only those infusion solutions the licensed nurse procures, removes from the sealed container and prepares. The licensed nurse is unable to verify that a solution that has been removed from its outer sealed container by another is the "right" drug, consistent with the "Five Rights" of medication safety.
- During an emergency situation, in an operating room or treatment room, licensed nurses working in the same room, at the same time, attending to the same patient may prepare an infusion solution together for immediate administration to a patient. At a minimum, both are responsible for communicating to each other regarding the medication order, validating the integrity of the medication, dosing pursuant to the administration order, and documentation, in accordance with the policies of the organization.
- The licensed nurse may administer infusion solutions that have, by organizational policies, been prepared in an area designed for admixture (e.g., when pharmacy compounds a sterile IV admixture under a laminar-airflow hood in a cleanroom) which have been labeled, repackaged, and resealed in the admixture area.
- To ensure safe IV admixture, some medications may require the solution, once mixed, be spiked and primed at the time of compounding before being placed in a sealed, appropriately labeled with verifiable contents.
- Solutions infusing at the time responsibility for the care of a patient is transferred from one licensed nurse to another may continue to infuse.
Professional Standards and references include, but are not limited to the following:
Infusion Nurses Society (INS) http://www.ins1.org
Association for Vascular Access (AVA) http://www.avainfo.org
Infusion Nurses Society, Society of Pediatric Nurses, Air & Surface Transport Nurses Association, American Association of Critical-Care Nurses, Emergency Nurses Association, and the Beazley Institute for Health Law and Policy, Loyola University Chicago College of Law Consortium Paper http://www.ins1.org/files/public/11_17_10_IOConsortium_paper_fixed_2010.pdf accessed 8/3/12
U.S. Agency for Healthcare Research and Quality (AHRQ) http://www.ahrq.gov/
The Joint Commission (TJC) http://www.jointcommission.org/
Centers for Medicare and Medicaid Services (CMS) http://www.cms.gov/
Department of Health and Human Services, CMS, Publication 100-07 State Operations Provider Certification, Transmittal 37, October 17, 2008.
CMS State Operations Manual, Appendix A – Survey Protocol, Regulations and Interpretive Guidelines for Hospitals, last revised 6/5/09; §482.12(a)(1)
2010 American Heart Association Guidelines for CPR & ECC