A Licensed Vocational Nurse (LVN), often called a Licensed Practical Nurse (LPN) in many states, is a licensed healthcare professional who provides direct patient care under the supervision of a physician or Registered Nurse (RN). Intravenous (IV) therapy involves placing a small catheter into a vein to administer fluids or medications. The specific act of starting a new IV line, known as a peripheral IV insertion or “IV start,” is a skill whose allowance for an LVN is not universal. Whether an LVN can perform this task and engage in other IV therapy procedures depends entirely on two factors: the laws of the state where they practice and the completion of specific, post-licensure training.
State Laws Govern LVN Scope of Practice
The legal framework defining the scope of practice for all nurses is established by the State Board of Nursing (BON) and codified in the state’s nurse practice act. These regulations dictate which procedures an LVN is authorized to perform, with significant variability across jurisdictional lines. Some states permit a certified LVN to initiate peripheral IVs, while others strictly reserve this procedure for Registered Nurses. This means an LVN permitted to start an IV in one state may be forbidden from doing so just across the border.
The foundational LVN education curriculum often does not include comprehensive instruction in venipuncture or IV therapy principles. Because of this educational gap, the state’s allowance for IV starts is conditional and requires a post-licensure validation of knowledge and skills. The state’s nurse practice act provides the legal authority for the performance of a skill, but the BON often issues position statements clarifying the specific conditions under which that authority can be exercised.
Requirements for LVN IV Certification
In states that permit LVNs to initiate peripheral IVs, authorization is contingent upon obtaining a specialized IV certification separate from the core LVN license. This certification process typically involves mandatory didactic instruction, which is classroom-based learning covering venous anatomy, fluid and electrolyte balance, and potential complications. The required number of instructional hours varies by state; for instance, some require a minimum of 30 hours of theory and lab practice.
Following the didactic portion, the LVN must complete a clinical practice component under the direct supervision of an authorized preceptor, such as an RN. This supervised practice requires the LVN to demonstrate proficiency in the technical skill of venipuncture and catheter insertion. Competency is validated through testing, which may include a written examination and a practical skills assessment, sometimes requiring a specific number of successful IV placements. The LVN must maintain this certification, as failure to keep it current immediately negates the legal ability to perform IV-related tasks.
Authorized IV Therapy Tasks
When an LVN is certified and practicing in a state that permits IV starts, their authorized tasks center on initiating peripheral lines and maintaining established IV access. A certified LVN can typically perform the venipuncture necessary to insert a peripheral IV catheter in the hand, forearm, or antecubital space. Once the line is established, the LVN is authorized to monitor the insertion site for potential complications, such as phlebitis or infiltration.
Routine maintenance tasks are also commonly authorized. These include adjusting the flow rate of the infusion, changing the IV dressing, and discontinuing the peripheral line when therapy is complete. Administration of non-complex solutions is generally permitted, such as hanging pre-mixed bags of normal saline or dextrose solutions. In some jurisdictions, the LVN may also administer certain premixed antibiotics or add specified electrolytes and vitamins to an existing bag of IV fluid.
Prohibited High-Risk IV Procedures
Despite obtaining IV certification, several high-risk procedures remain outside the LVN scope of practice due to the complexity and specialized assessment skills required. These advanced tasks are reserved for Registered Nurses or other advanced practitioners. LVNs are not permitted to initiate or manage central venous access devices, including Peripherally Inserted Central Catheters (PICCs) or central venous catheters (CVCs). Accessing implanted venous ports is also a prohibited task.
The administration of high-risk substances is another major limitation. This includes administering blood or blood products, managing chemotherapy, or giving medications like vasoactive drips or insulin infusions that require titration. Furthermore, the direct administration of medication via an intravenous push or bolus is generally prohibited, as this method delivers a concentrated dose directly into the bloodstream. LVNs are also typically not permitted to mix IV solutions, which requires advanced pharmacological knowledge to ensure compatibility and sterility.
The Importance of RN Supervision and Facility Policy
Even when state law permits a certified LVN to perform IV-related tasks, all actions must be conducted under the direction or supervision of a Registered Nurse, physician, or other authorized provider. The LVN’s scope of practice is considered a “directed scope,” meaning their practice is guided and overseen by a professional with a broader, independent license. This supervision is a regulatory requirement intended to ensure patient safety across all care settings.
Beyond state law, the policies established by the employing facility or hospital hold significant weight and can further limit practice. A facility policy can be more restrictive than the state’s nurse practice act; for instance, a hospital may prohibit all LVNs from initiating IVs, even if state law allows it. In this scenario, the LVN must adhere to the facility’s more stringent policy, as the facility retains the right to set its own standards for patient care.