Licensed Practical Nurses (LPNs) are integral members of the healthcare team, providing direct patient care. Intravenous (IV) therapy, which involves infusing fluids or medications directly into a vein, is a fundamental nursing skill that carries significant risk. Whether an LPN can perform IV therapy is complex because the scope of practice is not uniform across the United States. Authorization depends entirely on the specific state’s laws, known as the Nurse Practice Act, and the individual healthcare facility’s policies.
Why Scope of Practice Varies by State
The variation in LPN IV privileges stems from the structure of nursing regulation in the U.S. Each state and territory operates under its own Nurse Practice Act (NPA), which governs the practice of nursing. The State Board of Nursing (BON) in each jurisdiction interprets and enforces the NPA, dictating the precise limits of an LPN’s professional duties. This legal framework ensures nursing care adheres to a minimum standard of safety for the public.
The scope of practice is defined by the laws of the state where the LPN holds a license. Some states grant LPNs a broader scope in IV therapy after specialized training, while others maintain severe restrictions. For instance, some states require a Registered Nurse (RN) to be physically present when an LPN performs IV tasks, while others only require electronic supervision. LPNs must be familiar with their state’s BON regulations, as practicing outside this defined scope can result in disciplinary action or license revocation.
IV Tasks LPNs Are Generally Authorized to Perform
After meeting state-mandated training and competency requirements, LPNs are frequently authorized to perform several low-risk IV maintenance procedures. A primary task involves observing the peripheral intravenous site for signs of complications. These include infiltration (leakage of non-vesicant fluid into surrounding tissue) or phlebitis (inflammation of the vein wall). Recognizing and immediately reporting these adverse reactions is a core competency for LPNs involved in IV care.
LPNs are often permitted to manage the mechanics of an ongoing peripheral IV infusion. This includes adjusting the flow rate on non-medicated solutions, such as normal saline or D5W, or maintaining a continuous infusion pump as ordered. They also perform routine site care, including changing dressings on peripheral IV lines using sterile technique to prevent infection. LPNs are generally allowed to discontinue a peripheral IV catheter once the infusion is complete or no longer needed.
High-Risk IV Procedures Prohibited for LPNs
High-risk procedures requiring complex patient assessment and immediate intervention are almost universally prohibited from the LPN scope of practice. The administration of intravenous push (IVP) medications, which injects medication directly into the bloodstream for an immediate systemic effect, is often restricted due to the risk of rapid adverse reactions. While a few states allow LPNs to administer selected IVP medications to stable adult patients, this is an exception requiring additional certification.
LPNs are widely prohibited from accessing, managing, or drawing blood from central venous access devices, such as PICC lines, implanted ports, and central venous catheters. These devices terminate in a large central vein near the heart and carry an elevated risk of severe complications like air embolism or systemic infection. LPNs are also prohibited from administering blood or blood products, chemotherapy agents, and any medications requiring dosage titration based on patient response or laboratory values. Furthermore, the administration of IV therapy to fragile populations, such as pediatric or neonate patients, remains outside the general LPN scope of practice.
Mandatory IV Certification and Training Requirements
Even when the Nurse Practice Act permits LPNs to perform certain IV tasks, authorization is contingent upon completing specific post-licensure training. This specialized education ensures the LPN has the focused knowledge and technical skill to safely manage peripheral IV therapy. The training typically involves classroom hours covering topics such as vascular anatomy, fluid and electrolyte balance, infection control, and the identification of IV complications.
Following the didactic portion, LPNs must complete a supervised clinical practice component to demonstrate proficiency in IV skills. This hands-on training often aligns with standards set by the Infusion Nurse Society (INS) to ensure high-quality, evidence-based care. Beyond state-required certification, healthcare facilities mandate their own competency validation process, checking the LPN’s skills before independent practice is allowed.
Understanding the Difference Between LPN and RN IV Roles
The distinction between the LPN and Registered Nurse (RN) role in IV therapy centers on the level of independent judgment, assessment, and autonomy required. The RN’s scope of practice is significantly broader, encompassing the full range of infusion therapy. This includes initiating IV lines, comprehensive patient assessment, and administering all classes of medications, including IV push. This authority is based on the RN’s greater educational depth in pathophysiology and clinical decision-making.
LPNs, in contrast, operate with a limited and delegated scope. Their IV activities must occur under the supervision or direction of an RN, physician, or other authorized provider. The RN retains ultimate accountability for the patient’s overall plan of care, even when delegating specific, low-risk tasks to an IV-certified LPN. The RN is responsible for the initial comprehensive assessment, determining the patient’s suitability for the infusion, and evaluating the overall outcome of the therapy. This supervisory structure ensures patient safety.