IV Therapy

Overview of Iowa's Scope of Practice for LPNs Regarding IV Care

Introduction to IV Care Scope

  • Importance of understanding the scope of practice relevant to each state.

  • Overview of Iowa's scope of practice, differentiating it from national standards such as those monitored by NCLEX.

Key Components of Iowa’s IV Care Scope

  • Practicing Under Supervision:

    • All IV procedures must be performed under the supervision of a Registered Nurse (RN).

  • Restrictions on IV Fluids:

    • LPNs cannot engage with IV fluids containing medications.

    • Nonmedicated IVs are permissible but with limitations (e.g., IV fluids should not contain electrolytes or dextrose).

  • IV Fluid Initiation:

    • Initiating IV fluids must be conducted by an RN.

    • LPNs may assist in changing bags when fluid runs out but cannot initially set them up.

  • Modifications of IV Rates:

    • LPNs are prohibited from changing IV rates (e.g., increasing a normal saline flow rate).

    • Changes must be made by an RN, and the LPN can assist after the RN has made the adjustment.

  • Types of Medications and IV Procedures Restricted:

    • LPNs cannot administer maintenance doses through controlled pumps like PCA pumps (Patient Controlled Analgesia).

    • Medicated IV pushes, intravenous boluses, and blood products cannot be administered by LPNs.

    • IV therapy is not allowed for patients under 12 years or those weighing less than 8 pounds.

Procedures Allowed for LPNs

  • LPNs are permitted to:

    • Discontinue IVs after they are no longer needed.

    • Administer prefilled heparin or saline flushes for maintaining patent IV lines.

Purpose of IV Therapy

  • Goals of IV Therapy:

    • Maintain or prevent fluid and electrolyte imbalances.

    • Provide necessary medications: IVs are essential for administering drugs rapidly.

    • Facilitate blood transfusions.

    • Manage pain through IV medication delivery.

  • Monitoring Requirements:

    • IV sites must be inspected regularly (as per policy, generally every 2-4 hours).

    • Assess for:

    • Proper site condition (swelling, warmth, intaction).

    • Correct dressing on the IV site.

    • Verification of fluid type and rate against medical records.

  • Tubing Expiration:

    • Ensure that tubings are replaced timely as per facility rules (e.g., piggyback tubing may last 24 hours, while regular tubing may last up to 72-96 hours).

Critical Thinking in IV Management

  • Assessment Techniques:

    • Regularly observe IV lines for bubbles, kinks, and overall patient condition.

    • Document hourly outputs and compare to fluid intake.

  • Complication Management:

    • Trace IV tubing thoroughly to ensure compatibility of medications.

    • Ensure patient understanding of the procedure and therapy being administered.

IV Catheter Selection and Insertion

  • Types of IVs Explained:

    • Peripheral IVs: Common for short-term use; should be assessed for vein availability and appropriateness.

    • Midline Catheters: Longer duration; stays in place up to 28 days.

    • PICC Lines: Positioned to end near the heart; suitable for long-term therapy and frequent medication.

    • Central Lines: Inserted into larger veins (i.e., subclavian) for direct access to the central circulation.

  • Insertion Techniques:

    • Sterile techniques are crucial to avoid infection.

    • Proper site selection is critical for success.

Flushing IV Lines

  • Saline Flushing Protocols:

    • Flush before administering medications and periodically to maintain line patency (commonly every shift).

    • Aseptic technique prevents infection; cleaning the hub properly before connection is critical.

    • Flushing should utilize a push-pause technique for effective line clearance.

  • Assessing IV Condition:

    • Monitor for signs of infection or infiltration.

IV Fluids Administration Techniques

  • Continuous vs. Intermittent IV Delivery:

    • Continuous IV therapy for stable patients and intermittent IV pushes or piggybacks for medication delivery.

  • Volume Calculation: Ensuring accurate titration and flow rate mechanisms are employed (considering microliter versus macroliter drop factors).

Complications Related to IV Use

  • Recognizing Infiltration:

    • Symptoms include localized swelling, coolness, and possible pain at the site.

  • Identifying Phlebitis:

    • Signs may include redness, heat, swelling, and pain.

  • Air Embolism Risk Management:

    • Monitor and ensure no air is present in the IV tubing or allergy response.

  • Assessment and Documentation:

    • Careful documentation of catheter changes and conditions observed during assessments.

    • Notifying RNs of any complications immediately.

Conclusion and Questions

  • Discussion session regarding remaining queries and clarification of IV procedures and scope of practices among different states.

  • Reiterate importance of familiarity with state-specific regulations as they can significantly impact practice.

  • Encourage questions to enhance understanding of outlined procedures and protocols regarding IV care.