PURPOSE: This rule sets forth the requirements for qualified practical nurses as defined in this chapter to participate in the administration of intravenous infusion treatment modalities.

1. (1) Qualified practical nurses shall only perform venous access and intravenous (IV) infusion treatment modalities according to the specific provisions of section 335.016, RSMo, 20 CSR 2200- 5.010, and this chapter. A qualified practical nurse shall only perform such activities under the direction and supervision of a registered professional nurse or a person licensed by a state regulatory board to prescribe medications and intravenous infusion treatments (hereinafter the “licensed prescriber”).

2. (2) Qualified practical nurses who perform venous access and intravenous infusion treatment modalities shall—

   1. (A) Maintain accountability to the registered professional nurse or licensed prescriber who is directing and supervising the individual’s practical nursing care acts involving venous access and intravenous infusion treatment modalities;
   2. (B) Maintain ongoing, documented, specialized knowledge, education, skills, training, judgment, and experience related to practical nursing care acts involving venous access and intravenous infusion treatment modalities;
   3. (C) Ensure that appropriate, authorized prescriber orders for patient care involving venous access and intravenous infusion treatment modalities are in place before patient care is begun;
   4. (D) Only engage in practical nursing care acts involving venous access and intravenous infusion treatment modalities that are within the individual’s authorized scope of practice as specified in section 335.016, RSMo, 20 CSR 2200-5.010, and this chapter; and
   5. (E) Only engage in practice consistent with lawful written policies and procedures of the individual’s employer as well as any state or federal laws applicable to the individual’s employer.

3. (3) Registered professional nurses who direct and supervise qualified practical nurses in the performance of acts involving venous access and intravenous infusion treatment modalities shall—

   1. (A) Provide appropriate direction and supervision for practical nursing care acts involving venous access and intravenous infusion treatment modalities that are within the qualified practical nurse’s authorized scope of practice as specified in section 335.016, RSMo, 20 CSR 2200-5.010, and this chapter;
   2. (B) Provide appropriate direction and supervision based on reasonable and prudent assessments, judgments, and decisions concerning the specialized knowledge, education, skills, training, judgment, and experience of the qualified practical nurse designated to perform specific acts involving venous access and intravenous infusion treatment modalities; and
   3. (C) Only engage in direction, supervision, and practice consistent with lawful, written policies and procedures of the individual’s employer and any state or federal laws applicable to the individual’s employer.

4. (4) Qualified practical nurses who have documented competency verification by the individual’s employer, but who are not IV-Certified according to these rules, may—

   1. (A) Observe, monitor, and maintain pre-calculated intravenous parenteral fluid infusion flow rate including total parenteral nutrition, peripheral parenteral nutrition, blood, and blood products;
   2. (B) Observe and monitor peripheral venous access sites for evidence of developing complications;
   3. (C) Observe and monitor patient for evidence of adverse response to prescribed venous access and intravenous infusion treatment modalities;
   4. (D) Remove indwelling peripheral venous access devices that do not exceed three inches (3") in length, excluding mid-line catheters;
   5. (E) Obtain blood and blood products from the blood bank in accordance with established blood bank protocol;
   6. (F) Perform pre-transfusion blood and blood product crosschecking procedures at patient bedside with a registered professional nurse;
   7. (G) Perform phlebotomy for the purpose of obtaining blood specimens for laboratory testing and/or donor collection; and
   8. (H) Report and document actions taken and observations made.

5. (5) In addition to the functions and duties set forth in section (4), graduate practical nurses, IV-Certified licensed practical nurses, and licensed practical nurses who hold an active multistate license to practice under the nurse licensure compact who have documented competency verification by the individual’s employer may—

   1. (A) Calculate the flow of intravenous parenteral fluid infusions including total parenteral nutrition, peripheral parenteral nutrition, blood, and blood products;
   2. (B) Initiate peripheral venous access sites using devices that do not exceed three inches (3") in length, excluding mid-line catheters;
   3. (C) Administer parenteral intravenous fluid infusions including total parenteral nutrition and peripheral parenteral nutrition through established, patent peripheral venous lines and central venous lines;
   4. (D) Change peripheral venous administration set tubings and dressings;
   5. (E) Administer premixed drugs and solutions through established, patent peripheral and central venous lines either by continuous infusion or intermittent intravenous piggyback methods;
   6. (F) Maintain the patency of “locked” peripheral and central venous catheters with saline and/or heparin flush solutions;
   7. (G) Administer packaged drug systems containing diluent and drug through established, patent peripheral and central venous lines; and
   8. (H) Administer continuous or intermittent parenteral fluid infusions via electronic infusion pumps and controllers, which includes assembling and programming of the electronic infusion pump or controller.
6. (6) In addition to the functions and duties set forth in sections

7. (4) and (5), and with additional individualized education and experience that includes documented competency verification by the individual’s employer, graduate practical nurses, IV- Certified licensed practical nurses, and licensed practical nurses who hold an active multistate license to practice under the nurse licensure compact may—

   1. (A) Change central venous line administration set tubings and site dressings;
   2. (B) Obtain blood specimens for laboratory testing from established central venous catheters, which includes implanted vascular access port devices that have already been accessed;
   3. (C) Administer premixed pain medications via patient controlled analgesia pump (PCA), which includes assembling and programming of the pump;
   4. (D) Administer premixed drugs that will infuse via mechanical infusion devices, including but not limited to syringe pumps and disposable elastomeric devices; and
   5. (E) Administer drug(s) via the intravenous push or intravenous bolus mode of delivery.

8. (7) Graduate practical nurses, IV-Certified licensed practical nurses, and licensed practical nurses who hold an active multistate license to practice under the nurse licensure compact shall not, under any condition, perform the following functions or duties:

   1. (A) Administer anti-neoplastic drugs, commonly referred to as chemotherapy, via any intravenous infusion treatment modality. However, the qualified practical nurse may stop the flow of an infusion if an adverse reaction or complication is observed and immediately notify a RN to assess the situation;
   2. (B) Begin the initial or sequential administration of a transfusion of whole blood or blood product including, but not limited to, serum albumin;
   3. (C) Access the port reservoir of a central venous implanted vascular access port device;
   4. (D) Perform an intravenous admixture in which a syringe/ needle is used to add drug(s) to a parenteral fluid container, prior to the administration of the infusion;
   5. (E) Add drug(s) to the fluid container of an existing intravenous infusion;
   6. (F) Add drug(s) to an existing volume control set chamber;
   7. (G) Remove a mid-line catheter or any type of central venous catheter;
   8. (H) Participate in any intravenous infusion treatment modality involving neonates;
   9. (I) Administer intravenous medications used in thrombolytic therapy; and
   10. (J) Administer intravenous medications for procedural sedation/anesthesia or deep sedation.

AUTHORITY: section 335.017, RSMo 2016, and section 335.036, RSMo Supp. 2023.* This rule originally filed as 4 CSR 200-6.030. Original rule filed Sept. 1, 2005, effective April 30, 2006. Moved to 20 CSR 2200-6.030, effective Aug. 28, 2006. Amended: Filed Oct. 30, 2007, effective April 30, 2008. Amended: Filed March 8, 2013, effective Aug. 30, 2013. Amended: Filed April 3, 2023, effective Sept. 30, 2023. Emergency amendment filed Jan. 5, 2024, effective Jan. 22, 2024, expired July 19, 2024. Amended: Filed Jan. 5, 2024, effective June 30, 2024. *Original authority: 335.017, RSMo 1983, and 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, 2007, 2008, 2011, 2018, 2023.