Intravenous Infusion Treatment Administration Title Page

Rules of Department of Commerce and Insurance Division 2200—State Board of Nursing Chapter 6—Intravenous Infusion Treatment Administration Title Page

20 CSR 2200-6.020 Definitions ...... 3 20 CSR 2200-6.030 Intravenous Infusion Treatment Administration by Qualified Practical Nurses; Supervision by a Registered Professional Nurse...... 4 20 CSR 2200-6.040 Venous Access and Intravenous Infusion Treatment Modalities Course Requirements...... 5 20 CSR 2200-6.050 Approval Process for a Venous Access and Intravenous Infusion Treatment Modalities Course ...... 6 20 CSR 2200-6.060 Requirements for Intravenous Therapy Administration Certification...... 7

JOHN R. ASHCROFT (10/31/19) CODE OF STATE REGULATIONS 1 Secretary of State Chapter 6—Intravenous Infusion Treatment Administration 20 CSR 2200-6

Title 20—DEPARTMENT OF (7) Initiate—the performance of activities (17) Life threatening circumstances—refers COMMERCE AND INSURANCE involved in starting a prescribed intravenous to a physiologic crisis situation wherein pre- Division 2200—State Board of Nursing infusion treatment modality. scribed drug administration via manual intra- Chapter 6—Intravenous Infusion venous bolus or push drug administration is Treatment Administration (8) Injection/access port—a resealable cap or immediately essential to preserve respiration other component part designed to accommo- and/or heartbeat. 20 CSR 2200-6.020 Definitions date needles or needleless devices for the (18) Mid-line catheter—a catheter that is administration of solutions into the vascular PURPOSE: This rule defines the terms used inserted into a vein in the antecubital fossa system. throughout this chapter. and then advanced three inches to twelve inches (3"–12") into the proximal upper arm. (9) Intermittent—an intravenous infusion treat- (1) Administer—to carry out comprehensive activities involved in intravenous infusion ment modality administered at prescribed (19) Needleless system—a substitute for a treatment modalities that include, but are not intervals with periods of infusion cessation. needle or other sharp access device, which limited to, the following: observing; perform- may be available in blunt, recessed, or valve ing; monitoring; discontinuing; maintaining; (10) Intravenous administration—prescribed designs. regulating; adjusting; documenting; assess- intravenous infusion treatment modalities (20) Packaged drug systems—use-activated ing; diagnosing; planning; intervening; and involving the venous system that may include, containers which are compartmentalized and evaluating. but are not limited to, the performance of have pre-measured ingredients that form a such nursing interventions as the insertion of solution when mixed. (2) Board—the Missouri State Board of Nurs- a peripheral needle or a peripheral catheter, ing. the removal of venous blood, and/or the (21) Parenteral nutrition—the intravenous administration of an intravenous injection or administration of total nutritional needs for a (3) Central venous catheter—a catheter that is patient who is unable to take appropriate advanced through the internal jugular vein, parenteral fluid infusion. amounts of food enterally. cephalic or basilic vein in the antecubital fossa, or subclavian vein, with the catheter (11) Intravenous catheter or cannula—a hol- (22) Peripheral venous catheter—a catheter tip terminating in the superior vena cava. A low tube made of silastic, plastic, or metal that begins and terminates in a vein in an central venous catheter may also be inserted used for accessing the venous system. extremity (i.e., arm, hand, leg, or foot) or in into a femoral vein with the catheter tip then a vein in the scalp. terminating in the inferior vena cava. Central (12) Intravenous drug administration—any venous catheters may be used to administer prescribed therapeutic or diagnostic substance (23) Policy—a written statement of a recom- prescribed intravenous infusion treatment delivered into the bloodstream via a vein mended course of action intended to guide modalities or to perform prescribed intra- including, but not limited to, medications, decision making. venous infusion diagnostic procedures and nutrients, contrast media, blood, blood prod- include, but are not limited to, peripherally ucts, or other fluid solutions. (24) Premixed drugs for intravenous adminis- inserted central catheters (PICCs), external tration—those drugs compounded or prepared percutaneously placed central venous (13) Intravenous infusion treatment modali- by a pharmacy department, parenteral fluid catheters, tunneled central venous catheters, ty—refers to a variety of means/methods uti- or drug manufacturer, or mixed by a licensed and implanted central venous catheters with a lized in the introduction of a prescribed sub- registered professional nurse who possesses portal reservoir. stance and/or solution into an individual’s documented evidence of the necessary cognitive and psychomotor instruction by a venous system. (4) Cognitive and psychomotor instruction— licensed pharmacist. the process of acquiring the knowledge and related physical activities associated with a (14) Intravenous piggyback administration—a (25) Procedure—a written statement of steps specific skill or operation. secondary infusion into an established patent required to complete an action. primary intravenous line for the intermittent (5) Cognitive and psychomotor competency delivery of medications. (26) Qualified practical nurses—for the pur- verification—the confirmation that an indi- pose of this chapter, this term includes: vidual possesses the needed cognitive and (15) Intravenous bolus or push drug adminis- (A) Graduate practical nurses practicing in psychomotor abilities to perform a specific tration—the administration of medication Missouri within the time frame as defined in procedure or skill. rapidly into a vein, to enter the blood stream 20 CSR 2200-4.020(3); in a short period of time, and to provide a (B) Practical nurses with temporary per- (6) Delivery system—a product that allows mits to practice in Missouri; and specific systemic effect. for the intravenous administration of a drug (C) Practical nurses currently licensed to or parenteral fluid. The delivery system may practice in Missouri, unless specifically stat- (16) Licensed practical nurse (LPN)—a be integral or may have component parts, and ed otherwise within the text of the specific includes all products used in the administra- licensed practical nurse as defined in section rule. tion of intravenous infusion treatment modal- 335.016, RSMo, and licensed to practice in ities, from the solution container to the the state of Missouri and referred to as LPN (27) Registered professional nurse (RN)—a catheter. throughout this chapter. registered professional nurse as defined in

JOHN R. ASHCROFT (10/31/19) CODE OF STATE REGULATIONS 3 Secretary of State 20 CSR 2200-6—DEPARTMENT OF COMMERCE AND INSURANCE Division 2200—State Board of Nursing

section 335.016, RSMo, and licensed to prac- (D) Only engage in practical nursing care (F) Perform pre-transfusion blood and tice in the state of Missouri and referred to as acts involving venous access and intravenous blood product cross-checking procedures at RN throughout this chapter. infusion treatment modalities that are within patient bedside with a registered professional the individual’s authorized scope of practice nurse; AUTHORITY: section 335.017, RSMo 2000, as specified in section 335.016, RSMo, 20 (G) Perform phlebotomy for the purpose of and section 335.036, RSMo Supp. 2012.* CSR 2200-5.010, and this chapter; and obtaining blood specimens for laboratory This rule originally filed as 4 CSR 200-6.020. (E) Only engage in practice consistent with testing and/or donor collection; and Original rule filed Sept. 1, 2005, effective lawful written policies and procedures of the (H) Report and document actions taken April 30, 2006. Moved to 20 CSR 2200- individual’s employer as well as any state or and observations made. 6.020, effective Aug. 28, 2006. Amended: federal laws applicable to the individual’s Filed June 27, 2008, effective Dec. 30, 2008. employer. (5) In addition to the functions and duties set Amended: Filed March 8, 2013, effective forth in section (4), graduate practical nurses Aug. 30, 2013. (3) Registered professional nurses who direct and IV-Certified licensed practical nurses and supervise qualified practical nurses in the who have documented competency verifica- *Original authority: 335.017, RSMo 1983 and 335.036, performance of acts involving venous access RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, tion by the individual’s employer, may— 2007, 2008, 2011. and intravenous infusion treatment modalities (A) Calculate the flow of intravenous par- shall: enteral fluid infusions including total par- (A) Provide appropriate direction and enteral nutrition, peripheral parenteral nutri- 20 CSR 2200-6.030 Intravenous Infusion supervision for practical nursing care acts tion, blood, and blood products; Treatment Administration by Qualified involving venous access and intravenous infu- (B) Initiate peripheral venous access sites Practical Nurses; Supervision by a Regis- sion treatment modalities that are within the using devices that do not exceed three inches tered Professional Nurse qualified practical nurse’s authorized scope (3") in length, excluding mid-line catheters; of practice as specified in section 335.016, (C) Administer parenteral intravenous fluid PURPOSE: This rule sets forth the require- RSMo, 20 CSR 2200-5.010, and this chap- infusions including total parenteral nutrition ments for qualified practical nurses as ter; and peripheral parenteral nutrition through defined in this chapter to participate in the (B) Provide appropriate direction and established, patent peripheral venous lines supervision based on reasonable and prudent administration of intravenous infusion treat- and central venous lines; assessments, judgments, and decisions con- ment modalities. (D) Change peripheral venous administra- cerning the specialized knowledge, education set tubings and dressings; tion, skills, training, judgment, and experi- (1) Qualified practical nurses shall only per- (E) Administer premixed drugs and solu- ence of the qualified practical nurse form venous access and intravenous (IV) infu- tions through established, patent peripheral designated to perform specific acts involving sion treatment modalities according to the spe- and central venous lines either by continuous cific provisions of section 335.016, RSMo, 20 venous access and intravenous infusion treat- infusion or intermittent intravenous piggy- CSR 2200-5.010, and this chapter. A quali- ment modalities; and back methods; fied practical nurse shall only perform such (C) Only engage in direction, supervision (F) Maintain the patency of “locked” activities under the direction and supervision and practice consistent with lawful, written peripheral and central venous catheters with of a registered professional nurse or a person policies and procedures of the individual’s saline and/or heparin flush solutions; licensed by a state regulatory board to pre- employer and any state or federal laws appli- (G) Administer packaged drug systems scribe medications and intravenous infusion cable to the individual’s employer. containing diluent and drug through estab- treatments (hereinafter the “licensed prescriber”). (4) Qualified practical nurses who have doc- lished, patent peripheral and central venous umented competency verification by the indi- lines; and (2) Qualified practical nurses who perform vidual’s employer, but who are not IV-Certi- (H) Administer continuous or intermittent venous access and intravenous infusion treat- fied according to these rules, may: parenteral fluid infusions via electronic infu- ment modalities shall: (A) Observe, monitor, and maintain pre- sion pumps and controllers, which includes (A) Maintain accountability to the regis- calculated intravenous parenteral fluid infu- assembling and programming of the electron- tered professional nurse or licensed pre- sion flow rate including total parenteral ic infusion pump or controller. scriber who is directing and supervising the nutrition, peripheral parenteral nutrition, individual’s practical nursing care acts blood, and blood products; (6) In addition to the functions and duties set involving venous access and intravenous infu- (B) Observe and monitor peripheral forth in sections (4) and (5), and with addi- sion treatment modalities; venous access sites for evidence of develop- tional individualized education and experi- (B) Maintain ongoing, documented, spe- ing complications; ence that includes documented competency cialized knowledge, education, skills, train- (C) Observe and monitor patient for evi- verification by the individual’s employer, ing, judgment, and experience related to dence of adverse response to prescribed graduate practical nurses and IV-Certified practical nursing care acts involving venous venous access and intravenous infusion treat- licensed practical nurses may— access and intravenous infusion treatment ment modalities; (A) Change central venous line administra- modalities; (D) Remove indwelling peripheral venous tion set tubings and site dressings; (C) Ensure that appropriate, authorized access devices that do not exceed three inches (B) Obtain blood specimens for laboratory prescriber orders for patient care involving (3") in length, excluding mid-line catheters; testing from established central venous venous access and intravenous infusion treat- (E) Obtain blood and blood products from catheters, which includes implanted vascular ment modalities are in place before patient the blood bank in accordance with estab- access port devices that have already been care is begun; lished blood bank protocol; accessed;

4 CODE OF STATE REGULATIONS (10/31/19) JOHN R. ASHCROFT Secretary of State Chapter 6—Intravenous Infusion Treatment Administration 20 CSR 2200-6

(C) Administer premixed pain medications PURPOSE: This rule sets forth the minimum 4. Relationship between parenteral fluid via patient controlled analgesia pump (PCA), requirements for establishing and conducting treatment administration and the body’s which includes assembling and programming a course of instruction for qualified practical homeostatic and regulatory function with of the pump; and nurse participants to become IV-Certified in attention to the clinical manifestation of fluid (D) Administer premixed drugs that will the state of Missouri. and electrolyte imbalance and cellular physi- infuse over a minimum of thirty (30) minutes ology; via mechanical infusion devices, including, PUBLISHER’S NOTE: The secretary of state 5. Principles of infection control in but not limited to, syringe pumps and dispos- has determined that the publication of the venous access and parenteral fluid adminis- able elastomeric devices. entire text of the material which is incorpo- tration; rated by reference as a portion of this rule 6. Identification of various types of (7) Graduate practical nurses and licensed would be unduly cumbersome or expensive. equipment used in venous access and par- practical nurses shall NOT, under any condi- This material as incorporated by reference in enteral fluid administration, with content tion, perform the following functions or this rule shall be maintained by the agency at related to criteria for use of each, and means duties: its headquarters and shall be made available of troubleshooting for malfunctions; (A) Administer anti-neoplastic drugs, com- to the public for inspection and copying at no 7. Principles and practices related to monly referred to as chemotherapy, via any more than the actual cost of reproduction. intravenous drug and/or fluid administration intravenous infusion treatment modality. How- This note applies only to the reference mate- across the life span; ever, the qualified practical nurse may stop the rial. The entire text of the rule is printed 8. Nursing management of venous flow of an infusion if an adverse reaction or here. access and parenteral fluid administration complication is observed and immediately procedures that are commonly used in patient notify a RN to assess the situation; (1) A venous access and intravenous (IV) infu- care settings; (B) Begin the initial or sequential adminis- sion treatment modalities course shall prepare 9. Procedure for obtaining venous tration of a transfusion of whole blood or the non IV-Certified qualified practical nurse access including appropriate equipment blood product including, but not limited to, to safely perform the functions and proce- selection, psychological preparation of the serum albumin; dures inherent in selected intravenous infu- patient, site selection, aseptic skin prepara- (C) Access the port reservoir of a central sion treatment modalities as set forth in this tion, insertion and stabilization of the venous venous implanted vascular access port rule. access device, application of dressing to device; insertion site, and documentation of proce- (D) Perform an intravenous admixture in (2) Course providers shall only design and dure; which a syringe/needle is used to add drug(s) conduct a venous access and intravenous 10. Maintenance of venous access site to a parenteral fluid container, prior to the infusion treatment modalities course as spec- and parenteral fluid administration system administration of the infusion; ified in this rule. The course shall provide components according to established current (E) Add drug(s) to the fluid container of an sufficient instruction for the following quali- practices; existing intravenous infusion; fied practical nurse participants to become 11. Monitoring venous access site for (F) Add drug(s) to an existing volume con- IV-Certified in Missouri: evidence of local complications, parenteral trol set chamber; (A) A practical nurse currently licensed to fluid infusion flow rate, and response to treat- (G) Administer drug(s) via the intravenous practice in Missouri; ment; push or intravenous bolus mode of delivery (B) A practical nurse with a temporary 12. Adjusting parenteral fluid flow rate except when life-threatening circumstances permit to practice in Missouri; in various clinical situations; require such administration; (C) A graduate practical nurse of a non- 13. Procedure for removal of peripheral (H) Remove a mid-line catheter or any type Missouri practical nursing education program venous access device upon completion of the of central venous catheter; and seeking licensure in Missouri; or prescribed treatment or if suspected or con- (I) Participate in any intravenous infusion (D) A federal employee who possesses a firmed complications arise; treatment modality involving neonates. current license as a practical nurse in another 14. Calculation of drug dosage and par- state who is enrolling in a course provided by enteral fluid administration flow rates; and AUTHORITY: section 335.017, RSMo 2000, a federal facility located in Missouri. 15. Principles of phlebotomy. and section 335.036, RSMo Supp. 2012.* (B) The curriculum to be offered shall be This rule originally filed as 4 CSR 200-6.030. (3) Curriculum. approved by the board. Original rule filed Sept. 1, 2005, effective (A) The curriculum of a venous access and 1. The course provider shall develop the April 30, 2006. Moved to 20 CSR 2200- intravenous infusion treatment modalities curriculum. The course provider may select 6.030, effective Aug. 28, 2006. Amended: course shall include the following compo- an IV Therapy text of choice. The text may be Filed Oct. 30, 2007, effective April 30, 2008. nents: utilized as the curriculum stem. Content spe- Amended: Filed March 8, 2013, effective 1. Review of the Missouri Nursing Prac- cific to IV Therapy certification in Missouri Aug. 30, 2013. tice Act including the current venous access shall be added. The curriculum shall contain and intravenous infusion treatment modalities all of the components listed in paragraphs *Original authority: 335.017, RSMo 1983 and 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, regulations; (3)(A)1.–5. of this rule and be submitted to 2007, 2008, 2011. 2. Review of the policies and proce- the board for approval. dures of the clinical agency where practical (C) A course shall, at a minimum, consist experience is received; of: 20 CSR 2200-6.040 Venous Access and 3. Structure of the circulatory system 1. Thirty (30) hours of classroom and Intravenous Infusion Treatment Modalities including anatomical location and physiology skills laboratory instruction or its equivalent, Course Requirements of veins used for venous access; (e.g., faculty-student interactive study); and

JOHN R. ASHCROFT (10/31/19) CODE OF STATE REGULATIONS 5 Secretary of State 20 CSR 2200-6—DEPARTMENT OF COMMERCE AND INSURANCE Division 2200—State Board of Nursing

2. Eight (8) hours of supervised clinical (C) Faculty and course participants shall PURPOSE: This rule sets forth the approval practice, which shall include at least one (1) have access to the necessary intravenous process for a course provider to establish, successful performance of peripheral venous treatment equipment and patients/clients maintain, and discontinue a course of instruc- access and the initiation of an intravenous receiving intravenous treatment modalities, tion for qualified practical nurse participants infusion treatment modality on an individual. including pertinent medical records. to become IV-Certified in the state of Mis- (D) There shall be written course out- (D) There shall be a signed written agree- souri. comes that identify the expected competen- ment between the course provider of the cies of the participant upon completion of the course and each cooperating clinical facility (1) To obtain initial approval of a venous course. that specifies the roles, responsibilities, and access and intravenous infusion treatment (E) The course participant shall complete a liabilities of each party. This written agree- modalities course, the course provider shall pretest(s) in pharmacology, anatomy and ment will not be required if the only clinical submit a written proposal to the board. physiology, and asepsis to determine the par- facility to be used is also the provider of the (A) The proposal shall be written by and ticipant’s level of knowledge at the beginning course. bear the original signature of a registered pro- of the course. fessional nurse who holds a current undisci- (F) All classroom and clinical instruction (6) To successfully complete a venous access plined license or temporary permit to practice and practice shall be supervised by a regis- and intravenous infusion treatment modalities as a registered professional nurse in Mis- tered professional nurse designated by the course for the purpose of becoming IV-Certi- souri. provider and who meets the faculty qualifica- fied, the qualified participant shall: (B) The proposal shall contain the follow- tions as stated in section (4) of this rule. (A) Achieve a minimum grade of eighty ing: percent (80%) on a written final examination 1. Name of course provider; (4) Faculty Qualifications and Responsibili- of no fewer than fifty (50) multiple choice 2. Course objectives; ties. items; 3. Curriculum to be utilized including (A) Nursing faculty shall hold a current, (B) Demonstrate clinical competency in the the method(s) of delivery and the number of undisciplined license or temporary permit to mastery of the course objectives; and classroom and clinical hours; practice as a registered professional nurse in (C) Perform at least one (1) successful 4. Faculty qualifications; Missouri; and the license to practice profes- peripheral venous access and initiate an intra- 5. Name of designated course coordina- sional nursing has never been disciplined in venous infusion treatment modality on an tor; any jurisdiction. Nursing faculty shall have a individual. 6. Description and location of classroom minimum of two (2) years of clinical experi- and clinical facilities to be utilized; ence within the last five (5) years that includ- (7) Record Keeping. 7. Copies of the agreement with the clin- ed responsibility for performing venous (A) The provider of an approved course ical facilities to be utilized; access and intravenous infusion treatment shall maintain records documenting each par- 8. Maximum faculty to student ratio in modalities. ticipant’s attendance, scores, and competen- the clinical component; (B) All non-nurse faculty shall possess the cies. These records shall be kept for a period 9. Methods of participant evaluation of at least five (5) years. A copy of this record professional preparation and qualifications to used including final examination; shall be provided to the course participant. teach the specific content for which they are 10. Qualifications/requirements of course (B) The provider of an approved course responsible. shall award a certificate, using a form provid- participants; (C) For the clinical component of the ed by the board, to each participant who suc- 11. Policy delineating successful com- course, the maximum faculty to student ratio cessfully completes the course. pletion of the course; and shall be one to three (1:3) for observational (C) Within thirty (30) days of a partici- 12. Policy regarding records to be main- experiences and the performance of non-inva- pant’s successful completion of an approved tained. sive procedures and functions. The faculty to course, the designated course coordinator (C) The board shall review the proposal student ratio shall be one to one (1:1) during shall submit the required participant informa- and issue a letter to the course provider stat- the performance of peripheral venous access tion to the board on a form provided by the ing whether the program has been approved and initiation of an intravenous infusion treat- board. or denied. If the program is denied approval, ment modality on an individual. the board shall state the specific reasons for (D) The course provider shall designate a AUTHORITY: section 335.017, RSMo 2000, its denial. registered professional nurse to be the course and section 335.036, RSMo Supp. 2012.* coordinator who shall be responsible for all This rule originally filed as 4 CSR 200- (2) Requirements for Maintaining Course aspects of the course. 6.040. Original rule filed Sept. 1, 2005, Approval. effective April 30, 2006. Moved to 20 CSR (A) The provider of an approved course (5) Classroom and Clinical Facilities. 2200-6.040, effective Aug. 28, 2006. Amend- shall comply with any subsequent changes in (A) Classrooms shall be of sufficient size ed: Filed March 8, 2013, effective Aug. 30, this rule beginning with the first course par- and contain the necessary equipment and 2013. ticipants following the effective date of the teaching aids to implement the course. rule change. The course provider shall submit *Original authority: 335.017, RSMo 1983 and 335.036, (B) The clinical facilities utilized shall be RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, a written report to the board specifying the sufficient to allow for appropriate implemen- 2007, 2008, 2011. manner in which it will comply with the rule tation of the course and may include, but are change(s). The board shall approve the sub- not limited to, acute care, long-term care, mitted report prior to the entrance of the next ambulatory care, and community agencies 20 CSR 2200-6.050 Approval Process for a course participants. that provide intravenous infusion treatment Venous Access and Intravenous Infusion (B) The course provider shall notify the modalities. Treatment Modalities Course board in writing of all changes in information

6 CODE OF STATE REGULATIONS (10/31/19) JOHN R. ASHCROFT Secretary of State Chapter 6—Intravenous Infusion Treatment Administration 20 CSR 2200-6

that was submitted in its approved proposal. access and intravenous infusion treatment ment upon providing evidence of IV-Certifi- Changes shall be approved by the board prior modalities course. cation in another state or jurisdiction. to implementation. (A) Upon receipt of confirmation of suc- (A) Upon receipt of evidence of IV-Certifi- (C) The course provider shall keep the cessful completion of an approved course, the cation in another state or jurisdiction the board current as to the names of faculty and board shall issue a verification of IV-Certifi- board will issue a Verification of IV-Certifi- clinical facilities utilized. cation letter stamped with the board seal. cation letter stamped with the board seal and (D) The course provider shall submit an (B) Upon receipt of the verification of IV- stating the expiration date of the individual’s annual report to the board using the form pro- Certification letter from the board, the temporary permit. vided by the board. Failure to submit the licensed practical nurse may engage in practi- (B) Upon receipt of the Verification of IV- annual report will be cause for the board to cal nursing care acts involving venous access Certification letter from the board, the individ- withdraw its approval of the course. and intravenous infusion treatment modalities ual may engage in practical nursing care acts (E) The board maintains the authority to as specified in the provisions of section involving venous access and intravenous infu- randomly audit course providers for compli- 335.016, RSMo, 20 CSR 2200-5.010, and sion treatment modalities as specified in the ance with the requirements as stated in this this chapter. provisions of section 335.016, RSMo, 20 chapter. This includes review of records on- (C) The practical nurse’s next issued CSR 2200-5.010, and this chapter. site. license shall state LPN IV-Certified. (C) When all other licensure requirements are met, the license issued will state LPN IV- (3) Discontinuing an Approved Course. (2) A practical nurse who is currently licensed Certified. (A) To discontinue an approved course, a to practice in another state or jurisdiction of (D) If licensure requirements are not met letter bearing the signature of the course the United States, who is an applicant for by the expiration date stated on the Verifica- coordinator shall be submitted to the board licensure by endorsement in Missouri and has tion of IV-Certification letter and temporary stating: been issued a temporary permit to practice in permit, the individual shall cease performing 1. The date after which the provider will Missouri and is not IV-Certified in another all practical nursing care acts including those no longer offer the approved course; and state or territory can obtain IV-Certification related to intravenous infusion treatment 2. The name and address of the custodi- upon successful completion of a board- administration. an for the records required to be maintained approved venous access and intravenous infu- for a five (5)-year period. sion treatment modalities course. (4) Individuals who graduated from a board (B) The board shall issue a letter to the (A) Upon receipt of confirmation of suc- approved practical nursing program after course provider confirming that the course cessful completion of an approved course, the February 28, 1999 are exempt from taking a has officially been discontinued. board shall issue a Verification of IV-Certifi- separate venous access and intravenous infu- (C) If a course provider desires to reestab- cation letter stamped with the board seal and sion treatment modalities course to become lish an approved venous access and intra- stating the expiration date of the temporary IV-Certified. venous infusion treatment modalities course permit. (A) A graduate of such a practical nursing after a course has been officially discontin- (B) Upon receipt of the Verification of IV- program may perform the functions and ued, a new proposal shall be submitted as Certification letter from the board, the indi- duties related to venous access and intra- required by section (1). vidual may engage in practical nursing care venous infusion treatment modalities as acts involving venous access and intravenous delineated in 20 CSR 2200-6.030 until s/he AUTHORITY: section 335.017, RSMo 2000, infusion treatment modalities as specified in has received the results of the first licensure and section 335.036, RSMo Supp. 2012.* the provisions of section 335.016, RSMo, 20 examination taken by the nurse or until ninety This rule originally filed as 4 CSR 200-6.050. CSR 2200-5.010, and this chapter. (90) days after graduation, whichever first Original rule filed Sept. 1, 2005, effective (C) When all other licensure requirements occurs. April 30, 2006. Moved to 20 CSR 2200- are met, the license issued will state LPN IV- (B) Upon official notification of passing 6.050, effective Aug. 28, 2006. Amended: Certified. the licensure examination, the graduate prac- Filed March 8, 2013, effective Aug. 30, 2013. (D) If licensure requirements are not met tical nurse will be issued a Missouri license by the expiration date stated on the Verifica- stating LPN IV-Certified. *Original authority 335.017, RSMo 1985; 335.036, RSMo tion of IV-Certification letter and temporary 1975, amended 1981, 1985, 1993, 1995, 1999, 2007, 2008, 2011. permit, the individual shall cease performing (5) Graduate practical nurses as specified in all practical nursing care acts including those subsections 20 CSR 2200-6.040(2)(C) and related to intravenous infusion treatment (D) of this chapter who are seeking licensure 20 CSR 2200-6.060 Requirements for In- administration. by examination in Missouri and for whom the travenous Therapy Administration Certifi- board has received confirmation of successful cation (3) A practical nurse who is currently licensed completion of an approved venous access and to practice in another state or jurisdiction of intravenous infusion treatment modalities PURPOSE: This rule specifies the processes the United States, who is an applicant for course shall meet all licensure requirements by which practical nurses can be recognized licensure by endorsement in Missouri and has before a license stating LPN IV-Certified can as IV-Certified in the state of Missouri. been issued a temporary permit to practice in be issued. Missouri, and is IV-Certified in another state (1) A practical nurse who is currently or jurisdiction of the United States, or who has AUTHORITY: sections 335.017 and 335.036, licensed to practice in Missouri and who is completed a venous access and intravenous RSMo 2016.* This rule originally filed as 4 not Intravenous (IV)-Certified in Missouri infusion treatment modalities course in another CSR 200-6.060. Original rule filed Sept. 1, can obtain IV-Certification upon the success- state or jurisdiction of the United States, can 2005, effective April 30, 2006. Moved to 20 ful completion of a board approved venous obtain IV-Certification in Missouri by endorse- CSR 2200-6.060, effective Aug. 28, 2006.

JOHN R. ASHCROFT (10/31/19) CODE OF STATE REGULATIONS 7 Secretary of State 20 CSR 2200-6—DEPARTMENT OF COMMERCE AND INSURANCE Division 2200—State Board of Nursing

Amended: Filed June 27, 2008, effective Dec. 30, 2008. Amended: Filed March 8, 2013, effective Aug. 30, 2013. Amended: Filed Aug. 11, 2017, effective Feb. 28, 2018.

*Original authority: 335.017, RSMo 1983 and 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, 2007, 2008, 2011.

8 CODE OF STATE REGULATIONS (10/31/19) JOHN R. ASHCROFT Secretary of State