Title: Infusion Therapy

Advisory Ruling Number: 9204

Authority:

The Massachusetts Board of Registration in Nursing (Board) is created and authorized by Massachusetts General Laws (M.G.L.) c. 13, §§ 13, 14, 14A, 15 and 15D, and G.L. c. 112, §§ 74 through 81C to protect the health, safety, and welfare of the citizens of the Commonwealth through the regulation of nursing practice and education.  In addition, M.G.L. c.30A, § 8 authorizes the Board to make advisory rulings with respect to the applicability to any person, property or state of facts of any statute or regulation enforced or administered by the Board.  Each nurse is required to practice in accordance with accepted standards of practice and is responsible and accountable for his or her nursing judgments, actions, and competency.  The Board’s regulation at 244 CMR 9.03(6) requires all nurses to comply with any other law and regulation related to licensure and practice.

Date Issued: April 23, 1992

Date Revised: July 10, 2002, March 14, 2007, September 12, 2012, May 13, 2015

Scope of Practice:

Registered Nurse and Licensed Practical Nurse for Infusion Therapy

Registered Nurse for Intra-osseous Device Insertion and Removal

Purpose:

To guide the practice of Registered Nurses and Licensed Practical Nurses whose practice may include infusion therapy through vascular or intra-osseous access.

Advisory:

Consistent with organizational policy and procedure, Registered Nurse (RN) practice may include:

  • Short and midline peripheral intravenous device insertion and removal
  • Use of adjunct aids such as ultrasound for vein identification and selection
  • Intra-osseous device insertion using 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
  • Maintenance of the infusion site

Consistent with organizational policy and procedure, Licensed Practical Nurse (LPN) practice may include:

  • Short and midline 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
  • Maintenance of the infusion site

The RN or LPN whose practice includes infusion therapy must:

  • Assume only those responsibilities for which he/she has education, experience and current clinical competency to perform, and that are in compliance with established standards of nursing practice and institutional/agency policy and procedure.
  • Possess initial and ongoing competence as evidenced by documented completion of didactic and clinical continuing education programs, employing agency education programs, and/or certification by a recognized body of infusion therapy experts in the following:
  • Pre-insertion assessment and placement
  • Ongoing assessment and monitoring of indwelling catheter
  • Infection prevention and Standard Precautions
  • Identification, prevention, and management of complications
  • Patient /caregiver education
  • Removal of catheter
  • Documentation of assessment, insertion, and removal, as applicable
  • Surveillance/quality improvement/outcome measure participation and contribution
  • Use of adjunct aids such as ultrasound for vein identification and selection when applicable.  
  • Ensure documentation is current, complete, accurate and legible in all records required by federal and state law
  • Not administer an infusion solution that the nurse has not procured, removed from the sealed container, and prepared.  It is the Board’s position that it is not possible to safely verify the contents of a solution that has been removed from its outer, sealed container. 

However:

  • During an emergency situation, in an operating room or treatment room, a RN and/or LPN working in the same room, at the same time, attending to the same patient may collaboratively prepare an infusion solution for immediate patient administration.  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. 
  • A RN or LPN may administer infusion solutions that have, by organizational policies, been prepared in an area designed for sterile admixture which have been labeled, repackaged, and resealed within the same admixture area (e.g., when pharmacy compounds a sterile IV admixture under a laminar-airflow hood in a cleanroom). 
  • 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 container. 
  • Solutions infusing at the time responsibility for patient care is transferred from one RN or LPN to another RN or LPN may continue to infuse.

The nurse in a management role must ensure the availability of sufficient resources to provide for safe implementation, including, but not limited to organizational policies that provide for:

  • Protocols for requiring and providing appropriate infusion therapy education
  • Protocols for assessing and documenting the education received and validation for RN and LPN initial and continued competency for each activity
  • Nursing care responsibilities, including, but not limited to patient assessment, monitoring, medication administration, potential complications, and documentation criteria
  • Emergency protocols including, but not limited to, immediate, on site availability of emergency equipment, medications and personnel

References and professional nursing standards include, but are not limited to the following:

Infusion Nursing Standards of Practice. Supplement to January/February 2011 Journal of Infusion Nursing. Volume 34, Number 1S, ISSN 1533-1458; accessed 4/8/15 at http://www.ins1.org

Association for Vascular Access (AVA) position paper The Use of Seldinger or Modified Seldinger Technique, in Combination with Real-Time Imaging Modalities for Peripherally Inserted Central Catheter and Midline Placements by Clinicians; accessed 4/8/15 at 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; accessed 4/8/15 at  http://www.ins1.org/files/public/11_17_10_IOConsortium_paper_fixed_2010.pdf

This information is provided by the Division of Health Professions Licensure within the Department of Public Health.