Friday, February 21, 2014

Can a Medical Assistant or LVN Access a Central Venous Catheter?

IV Certification Training
Infusion Therapy is a growing industry and we have more and more patients going home with implanted ports, temporary dialysis catheters, and other types of Central Venous Catheters (CVC).  We get many questions regarding the scope of LVN's/LPN's and what they can and cannot do in regards to infusion therapy.

For the sake of this article we will use the term Licensed Vocational Nurse (LVN) as this is what they are referred to here in California. 

However, most states still refer to an LVN as and LPN or Licensed Practical Nurse.  That is another discussion in its entirety.

California is one of the only states that we know of at this time that requires LVN's to gain an IV Certification in order to perform IV TherapyPedagogy has a great link that one may use as a resource to determine what an LVN can and cannot do in regards to infusion therapy.

Here is California it is illegal for a Medical Assistant (MA) to start an IV or even access a central line even under a physician's supervision as this is not within their scope of practice.  We have had many calls from medical assistants who have wanted to attend our IV Certification Classes however, we have had to decline them for this particular reason; and the same goes for an EMT-I.

LVN's here in California can perform IV Therapy as long as they have attended an IV Certification Class approved by the BVNPT or the Board of Vocational Nursing.  

 According to Article 10- Intravenous Therapy/Blood Withdrawal in the LVN Scope of Practice it states the following:

“2547. Definition-As used in this Article:

(a) “Intravenous fluids” means fluid solutions of electrolytes, nutrients, vitamins, blood and blood products.

(b) “Superimpose” means to connect a container of intravenous fluid to tubing through which another container of intravenous fluid has just been administered.

(c) “Primary infusion line” means the line which provides a direct infusion between the container and the peripheral vein.

(d) “Secondary infusion line” means a line which provides infusion through a lateral access into a primary infusion line”

IV Certification Classes
It does not specify whether an LVN can or cannot access and central venous catheter specifically in the LVN regulations.  We believe it is safe to say that most facilities throughout California have policies and procedure that do not allow LVN's to access CVC's and if for any reason they allow it; they will most likely train the LVN's and have policies and guidelines in place to monitor competency.  We teach our students that most likely that will not be accessing central venous catheters but should be able to safely care for and change the dressings of CVC's as long as their facility allows it and has policies in place.  In our teaching we follow the Infusion Nurses Society (INS) Infusion Nursing Standards of Practice as well as the guidelines and recommendations from the Association for Vascular Access (AVA).

So, in short we feel the best advice for any LVN/LPN in regards to accessing or manipulating a CVC is to carefully read of the LVN Nurses Practice Act as well as the policies and procedure in your workplace. If there is no clear answer from your nurses practice act you may then want to contact your own state board of nursing.  Most Boards of Nursing have the ability of allowing you to submit a question to the board for a response. Lastly, a great resource would be your facility's risk manager.