North Dakota: Role of Lpn in IV Therapy
LPN IV Therapy Guidelines
The use of intravenous therapy is not without its risks (David, 2007). A saline bolus, for example, will cause edema as three quarters of the fluid leaves the vascular bed immediately after administration. In contrast to a lay person's expectations, common isotonic solutions, such as Lactated Ringers solution, can induce an inflammatory response. The inflammation is caused by neutrophils destroying tissue through apoptosis and the release of reactive oxygen species, possibly triggering respiratory distress.
Kim David (2007) provides an overview of intravenous solutions in common use and their inherent dangers. She also discusses ongoing controversies concerning when to use intravenous fluids to resuscitate trauma patients. For example, most trauma patients will do better if hypotension is left untreated, except for patients who have suffered traumatic brain injury. Researchers have also shown that giving too much fluid perioperatively to major surgery patients increases the risk of pulmonary edema, atelectasis, and pneumonia.
Given the risks to patient safety that improperly administered intravenous therapy represents, nursing boards have established clear guidelines describing who is authorized to administer fluids and under what circumstances. The North Dakota Board of Nursing (NDBN) restricts...
North Dakota requires LPNs to be properly trained and board certified in intravenous therapy; however, intravenous therapy must also be done according to organization policy and under the supervision of a registered nurse (RN), advanced practice RN (APRN), or licensed practitioner. In addition, LPNs can only administer intravenous therapy to stabilized patients.
If the above criteria are met then an LPN in North Dakota can manage all aspects of intravenous therapy (NDBN, 2012). An LPN can start or stop intravenous therapy, monitor the infusion and the patient's response, document the procedure and any changes in patient status, add medications, and replace empty containers with prescribed solutions. LPNs can also flush or change the lines as needed and change dressings.
An intravenous medication bolus can be administered by an LPN, but only according to organization policy and with over-the-shoulder supervision by an RN, APRN, or licensed practitioner (NDBN, 2012). The supervising healthcare organization is also responsible for deciding which drugs an LPN can or cannot administer using an intravenous line and under what circumstances blood can be withdrawn or blood products administered to a stabilized patient. In addition, the NDBN requires LPNs to complete an organization…
