Definitions

PURPOSE: This rule defines the terms used throughout this chapter. (1) Administer—to carry out comprehensive activities involved in intravenous infusion treatment modalities that include, but are not limited to, the following: observing; performing; monitoring; discontinuing; maintaining; regulating; adjusting; documenting; assessing; diagnosing; planning; intervening; and evaluating. (2) Board—the Missouri State Board of Nursing. (3) Central venous catheter—a catheter that is advanced through the internal jugular vein, cephalic or basilic vein in the antecubital fossa, or subclavian vein, with the catheter tip terminating in the superior vena cava. A central venous catheter may also be inserted into a femoral vein with the catheter tip then terminating in the inferior vena cava. Central venous catheters may be used to administer prescribed intravenous infusion treatment modalities or to perform prescribed intravenous infusion diagnostic procedures and include, but are not limited to, peripherally inserted central catheters (PICCs), external percutaneously placed central venous catheters, tunneled central venous catheters, and implanted central venous catheters with a portal reservoir. (4) Cognitive and psychomotor instruction—the process of acquiring the knowledge and related physical activities associated with a specific skill or operation. (5) Cognitive and psychomotor competency verification— the confirmation that an individual possesses the needed cognitive and psychomotor abilities to perform a specific procedure or skill. (6) Delivery system—a product that allows for the intravenous administration of a drug or parenteral fluid. The delivery system may be integral or may have component parts, and includes all products used in the administration of intravenous infusion treatment modalities, from the solution container to the catheter. (7) Initiate—the performance of activities involved in starting a prescribed intravenous infusion treatment modality. (8) Injection/access port—a resealable cap or other component part designed to accommodate needles or needleless devices for the administration of solutions into the vascular system. (9) Intermittent—an intravenous infusion treatment modality administered at prescribed intervals with periods of infusion cessation. (10) Intravenous administration—prescribed intravenous infusion treatment modalities involving the venous system that may include, but are not limited to, the performance of such nursing interventions as the insertion of a peripheral needle or a peripheral catheter, the removal of venous blood, and/or the administration of an intravenous injection or parenteral fluid infusion. (11) Intravenous catheter or cannula—a hollow tube made of silastic, plastic, or metal used for accessing the venous system. (12) Intravenous drug administration—any prescribed therapeutic or diagnostic substance delivered into the bloodstream via a vein including, but not limited to, medications, nutrients, contrast media, blood, blood products, or other fluid solutions. (13) Intravenous infusion treatment modality—refers to a variety of means/methods utilized in the introduction of a prescribed substance and/or solution into an individual’s venous system. (14) Intravenous piggyback administration—a secondary infusion into an established patent primary intravenous line for the intermittent delivery of medications. (15) Intravenous bolus or push drug administration—the administration of medication rapidly into a vein, to enter the blood stream in a short period of time, and to provide a specific systemic effect. (16) Licensed practical nurse (LPN)—a licensed practical nurse as defined in section 335.016, RSMo, and licensed to practice in the state of Missouri and referred to as LPN throughout this chapter. (17) Life threatening circumstances—refers to a physiologic crisis situation wherein prescribed drug administration via manual intravenous bolus or push drug administration is immediately essential to preserve respiration and/or heartbeat. (18) Mid-line catheter—a catheter that is inserted into a vein in the antecubital fossa and then advanced three inches to twelve inches (3"–12") into the proximal upper arm. (19) Needleless system—a substitute for a needle or other sharp access device, which may be available in blunt, recessed, or valve designs. (20) Packaged drug systems—use-activated containers which are compartmentalized and have pre-measured ingredients that form a solution when mixed. (21) Parenteral nutrition—the intravenous administration of total nutritional needs for a patient who is unable to take appropriate amounts of food enterally. (22) Peripheral venous catheter—a catheter that begins and terminates in a vein in an extremity (i.e., arm, hand, leg, or foot) or in a vein in the scalp. (23) Policy—a written statement of a recommended course of action intended to guide decision making. (24) Premixed drugs for intravenous administration—those drugs compounded or prepared by a pharmacy department, parenteral fluid or drug manufacturer, or mixed by a licensed registered professional nurse who possesses documented evidence of the necessary cognitive and psychomotor instruction by a licensed pharmacist. AND INSURANCE (25) Procedure—a written statement of steps required to complete an action. (26) Qualified practical nurses—for the purpose of this chapter, this term includes: (A) Graduate practical nurses practicing in Missouri within the time frame as defined in 20 CSR 2200-4.020(3); (B) Practical nurses with temporary permits to practice in Missouri; and (C) Practical nurses currently licensed to practice in Missouri, unless specifically stated otherwise within the text of the specific rule. (27) Registered professional nurse (RN)—a registered professional nurse as defined in section 335.016, RSMo, and licensed to practice in the state of Missouri and referred to as RN throughout this chapter. AUTHORITY: section 335.017, RSMo 2000, and section 335.036, RSMo Supp. 2012.* This rule originally filed as 4 CSR 200-6.020. Original rule filed Sept. 1, 2005, effective April 30, 2006. Moved to 20 CSR 2200-6.020, effective Aug. 28, 2006. Amended: Filed June 27, 2008, effective Dec. 30, 2008. Amended: Filed March 8, 2013, effective Aug. 30, 2013. *Original authority: 335.017, RSMo 1983 and 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, 2007, 2008, 2011.