Chapter 20. Management of Infusion Therapy by the Registered Nurse and the Licensed Practical Nurse
Regulation .01 Exclusion from Regulations.LinkCopy Citation
This chapter is not applicable to, and does not restrict or limit, other health care practitioners who are authorized to perform these duties under their respective laws.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Administer” means to hang or give subsequent fluids and medications.
(2)
“Antineoplastic” means:
(a)
Chemical or biologic agents that have a toxic effect on the disease-causing agent or modify the host environment; or
(b)
Drugs that are capable of destroying invading organisms or malignant tumor cells.
(3)
“Arterial catheter” means a catheter or needle inserted into an artery.
(4)
“Assign” means to designate another licensee to be responsible and accountable to perform nursing acts that are within the licensee's scope of practice, knowledge, judgment, and skill.
(5)
“Central venous catheter (CVC)” means a catheter whose tip is located in a central vessel.
(6)
“Chronic dialysis client” means a client with end stage renal disease who is receiving routine dialysis treatments in an outpatient facility.
(7)
“Clinical competence” means the demonstrated ability to perform the identified IV tasks consistent with the standards established by the INS, ONS, or other bodies approved by the Board.
(8)
“Comprehensive assessment” means a nursing assessment that includes:
(a)
The specific individual patient's clinical status;
(b)
Medical treatment regime; and
(c)
Complexity of the infusion therapy treatment regime including:
(i)
The purpose and effects of the specific infusate or medication;
(ii)
Skills to access and de-access the infusion catheter access device; and
(iii)
The potential harm to the patient should an error occur.
(9)
Direct Supervision.
(a)
“Direct supervision” means oversight exercised by a registered nurse who is present on the unit of care during the infusion therapy process.
(b)
“Direct supervision” includes the actions of:
(i)
Observation;
(ii)
Assessment;
(iii)
Evaluation; and
(iv)
Direction.
(10)
“First dose” has the meaning defined by the facility's policies and procedures.
(11)
“Hypodermoclysis” means the infusion of fluids into subcutaneous tissue for hydration.
(12)
Implanted Port.
(a)
“Implanted port” means a reservoir surgically placed under the skin and attached to a catheter which is placed in a vessel, body cavity, or organ.
(b)
“Implanted port” is often referred to as a medi-port, port-a-cath, infuse-a-port, infusion port, or a subcutaneous port.
(13)
“Implanted pump” means a catheter surgically placed into a vessel, body cavity, or body space, and attached to a reservoir placed under the skin, that contains a pumping mechanism for continuous medication administration.
(14)
“Infusion therapy” means the initiation and administration of medication, fluids, and nutrients via an intravenous access device.
(15)
“Initiate” means to hang and administer the first dose of medications or fluids.
(16)
“INS” means Infusion Nurses Society.
(17)
“Intraventricular reservoir” means a catheter threaded through the dura into a ventricle of the brain.
(18)
“Licensee” means a registered nurse or licensed practical nurse.
(19)
“LPN” means an individual who:
(a)
Is licensed by the Board to practice licensed practical nursing; or
(b)
Has a multistate licensure privilege to practice licensed practical nursing.
(20)
“Midclavicular catheter” means a peripherally inserted catheter with the distal tip located between the axilla and the vena cava.
(21)
“Midline catheter” means a peripherally inserted catheter with the tip terminating below the axilla.
(22)
“Multi-lumen catheter” means a venous access device that has more than one lumen.
(23)
“Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.
(24)
“Non-tunneled catheter” means a percutaneously placed catheter inserted into the vein.
(25)
“ONS” means Oncology Nursing Society.
(26)
“On-site supervision” means oversight exercised by a supervising registered nurse who is:
(a)
Present in the facility; and
(b)
Quickly and easily available to the patient and the assigned nurse during the course of infusion therapy.
(27)
“Peripheral catheter” means a catheter or needle inserted into a superficial vein with the tip residing outside of the central venous system.
(28)
“Peripheral veins” means those veins in the superficial aspects of the body excluding the external jugular vein.
(29)
“Peripherally inserted central catheter (PICC)” means a catheter, inserted with or without a guide wire, whose tip is located in the vena cava.
(30)
“PPN” means partial parenteral nutrition.
(31)
“Registered nurse (RN)” means an individual who:
(a)
Is licensed by the Board to practice registered nursing; or
(b)
Has a multistate licensure privilege to practice registered nursing.
(32)
“Specialized catheter” means an epidural, intrathecal, intrapleural, or peripheral nerve catheter.
(33)
“Subcutaneous infusion of medication” means a continuous or intermittent infusion of medication by an indwelling needle or catheter inserted into subcutaneous tissue.
(34)
“TPN” means total parenteral nutrition administered into the central venous system.
(35)
“Tunneled catheter” means a CVC designed to have a portion of the catheter lie in a subcutaneous passage before exiting the body.
(36)
“Nonsurgically placed” means a catheter placed percutaneously.
Regulation .03 Education.LinkCopy Citation
To perform infusion therapy, the licensee shall:
A.
Complete an infusion therapy program of study which contains didactic content and a clinical practicum consistent with the standards of practice established by the INS or other bodies approved by the Board that includes but is not limited to:
(1)
Infusion access devices;
(2)
Selected infusates, blood, and blood components;
(3)
Nursing assessment and monitoring skills required for the infusion therapy acts to be performed;
(4)
Management of complications related to the infusion therapy and access devices; and
(5)
Delivery devices;
B.
Have documented evidence of clinical competency before independently:
(1)
Inserting infusion devices; or
(2)
Managing the care of patients receiving infusion therapy;
C.
Perform the infusion therapy acts on a frequent routine predictable basis in order to retain practice proficiency;
D.
Be evaluated for continued clinical competency at planned periodic time intervals; and
E.
Obtain additional education on nursing assessment and monitoring when the patient population changes.
Regulation .04 Infusion Therapy Acts — General.LinkCopy Citation
A.
The licensee shall comply with the employer's written policies and procedures which are in compliance with this chapter regarding infusion therapy.
B.
The licensee shall maintain medical records in accordance with Health-General Article, Title 4, Subtitle 4, Annotated Code of Maryland.
Regulation .05 Infusion Therapy Acts — LPN.LinkCopy Citation
A.
The LPN may perform the following infusion therapy acts for peripheral and subcutaneous infusions when there is an RN on site or available by telephone:
(1)
Calculate and adjust flow rate including pumps;
(2)
Observe and report on:
(a)
Insertion site; and
(b)
Objective and subjective signs of adverse reactions to infusion therapy;
(3)
Change the dressing on the insertion site;
(4)
Change the administration set;
(5)
Insert subcutaneous needle or catheter to:
(a)
Rotate sites for an existing infusion; and
(b)
Administer a medication which is routine for the patient;
(6)
Insert a peripheral IV needle or catheter (excluding midline) to:
(a)
Withdraw a blood specimen; or
(b)
Initiate IV fluids;
(7)
Remove a peripheral and subcutaneous IV needle or catheter;
(8)
Flush a peripheral and midline IV device;
(9)
Convert an existing continuous infusion to an intermittent infusion;
(10)
Convert an intermittent infusion to a continuous infusion;
(11)
Change injection cap;
(12)
Insert device and initiate hypodermoclysis and add replacement solutions; and
(13)
Administer medication via a peripheral IV line (including midline) using:
(a)
Pharmacy-prepared medication; and
(b)
PPN solutions; and
(14)
Add medications to an intravenous solution.
B.
The LPN may perform the following acts for midclavicular, CVC, PICC, and implanted ports:
(1)
Calculate and adjust flow rate including a pump;
(2)
Observe and report on:
(a)
The insertion site; and
(b)
Objective and subjective signs of adverse reactions to infusion therapy;
(3)
Change the dressing on the insertion site;
(4)
Flush a midclavicular, PICC, CVC, and an accessed implanted port;
(5)
Change injection cap;
(6)
Change administration sets;
(7)
Convert an existing continuous infusion to an intermittent infusion; and
(8)
Convert an intermittent infusion to a continuous infusion.
C.
The LPN may perform the following additional acts under the direct supervision of the RN following a comprehensive patient assessment:
(1)
Administer TPN via PICC, implanted ports, or CVC;
(2)
Administer medications by midclavicular, PICC, CVC, and implanted ports by hanging pharmacy prepared solutions;
(3)
Add medication to a solution administered via PICC, midclavicular CVC, and implanted ports;
(4)
Observe, monitor, and report on the patient:
(a)
With specialized catheters; and
(b)
During a blood transfusion;
(5)
Initiate and administer blood and blood components;
(6)
Draw blood specimens via midline, PICC, CVC, and implanted ports;
(7)
Access and de-access implanted ports; and
(8)
Initiate the first dose of a medication after it has been reviewed and evaluated for potential risk by the RN.
D.
On completion of a second specialized educational program in infusion therapy, containing didactic content and a clinical practicum, consistent with the standards of ONS or other bodies approved by the Board and with documented evidence of clinical competency, the LPN may administer standardized doses of non-vesicant chemotherapeutic agents and antiviral agents to an existing infusion in accord with the facility's written protocol or practice guidelines. The LPN shall perform these additional procedures under the direct supervision of the RN following a comprehensive patient assessment.
E.
The LPN may perform additional infusion therapy acts in a licensed outpatient dialysis facility serving the chronic dialysis client when:
(1)
The requirements of Regulations .03 and .04 of this chapter and §§A—C of this regulation have been met;
(2)
The outpatient dialysis unit RN skilled in chronic dialysis has taught a didactic and clinical practicum for the LPN which includes but is not limited to:
(a)
Pharmacological interventions specific to:
(i)
Physiological alterations and effects of chronic renal failure;
(ii)
Indication, dosage, side effects, and contraindications of each drug intervention; and
(iii)
Special considerations of each drug intervention specific to the chronic renal failure client; and
(b)
Route of medication administration and access delivery systems;
(3)
The outpatient dialysis RN documents evidence of the LPN's clinical competency of the additional activities under §F of this regulation.
F.
The LPN may perform the following additional infusion acts, that may include the flushing of catheters, in a licensed outpatient dialysis facility serving the chronic dialysis client under the direct supervision of the RN skilled in chronic dialysis:
(1)
Venipuncture for the purpose of hemodialysis;
(2)
Initiation of and discontinuation from dialysis utilizing the various accesses, including:
(a)
Subclavian catheters;
(b)
Internal jugular catheters;
(c)
Femoral vein catheters;
(d)
Arterial catheters;
(e)
Fistulas; and
(f)
Grafts;
(3)
Withdrawal of blood and heparinized saline from the various accesses for the purpose of removing the heparin and establishing patency;
(4)
Withdrawal of blood from access for the purpose of obtaining blood for a laboratory specimen;
(5)
Administration of IV medications and solutions during hemodialysis;
(6)
Performance of dressing changes to various access device sites; and
(7)
Administration of the following medications by IV “push” per physician order and nationally recognized standards of care:
(a)
Anticoagulant agents;
(b)
Saline;
(c)
Erythropoeitic agents;
(d)
Vitamin D products;
(e)
Iron preparation agents; and
(f)
Anti-emetic agents.
G.
The LPN may not perform the following acts:
(1)
Administer medication via IV “push”, except as set forth in §F(7) of this regulation;
(2)
Insert a midline catheter;
(3)
De-clot the catheter;
(4)
Repair a catheter;
(5)
Insert and remove PICC, midline catheters, and midclavicular catheters;
(6)
Manage specialized catheters for analgesia; and
(7)
Remove nonsurgically placed central and arterial catheters.
Regulation .06 Infusion Therapy Acts — RN.LinkCopy Citation
A.
In addition to all previously identified procedures in Regulations .04 and .05A—C of this chapter, the RN may perform the following procedures:
(1)
Administer medication via IV “push”;
(2)
Initiate subcutaneous infusion of medication; and
(3)
Provide care and manage arterial catheters and arterial ports by:
(a)
Changing IV administration set;
(b)
Flushing or aspirating;
(c)
Changing dressing;
(d)
Obtaining blood specimens;
(e)
Accessing and de-accessing; and
(f)
Changing injection cap.
B.
The RN, upon completion of a second specialized educational program in infusion therapy which includes didactic content and a clinical practicum consistent with the standards established by the ONS or other bodies approved by the Board and with documented evidence of clinical competency, may perform the following additional infusion therapy activities:
(1)
Administer antineoplastic agents;
(2)
Aspirate fluid from an intraventricular reservoir;
(3)
Administer fluids and medications via an intraventricular reservoir;
(4)
Manage implantable pumps by programming and filling with fluids and medications;
(5)
Insert, repair, and remove PICC and midclavicular catheters;
(6)
Insert and remove midline catheters;
(7)
Manage specialized catheters for analgesia;
(8)
Remove nonsurgically placed central and arterial catheters;
(9)
Administer pharmacological agents to de-clot or restore blood return; and
(10)
Repair a catheter.
C.
The RN may not perform the following acts:
(1)
Administer the initial dose of any medication by intrathecal, epidural, intrapleural, or peripheral nerve catheter; or
(2)
Remove any tunneled catheter.
Chapter annotations
Authority: Health-General Article, §4-403; Health Occupations Article, §8-205; Annotated Code of Maryland
History: Effective date: October 7, 1996 (23:20 Md. R. 1423)
History: Regulations .01—.04 repealed and new Regulations .01—.06 adopted effective November 15, 1999 (26:23 Md. R. 1777)
History: Regulation .02B amended effective October 27, 2003 (30:21 Md. R. 1529); July 2, 2018 (45:13 Md. R. 667)
History: Regulation .03 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .04 amended effective July 2, 2018 (45:13 Md. R. 667); October 13, 2025 (52:10 Md. R. 1002)
History: Regulation .05 amended effective October 27, 2003 (30:21 Md. R. 1529)
History: Regulation .06B amended effective October 27, 2003 (30:21 Md. R. 1529)