Section 21.413. Interpretations regarding the administration of drugs—statement of policy

(a) The following nursing practices fall within the scope of registered nursing practice under § § 21.11, 21.12 and 21.14 (relating to general functions; venipuncture; intravenous fluids; and administration of drugs):

(1) Intravenous administration of Pavulon to a patient maintained on a mechanical ventillator.

(2) Use of lidocaine as an analgesic prior to venipuncture.

(3) Use of lidocaine or xylocaine for analgesia prior to use of a vascular access device of an implantable infusion pump.

(b) The following nursing practices fall within the scope of registered nursing practice under § § 21.11 and 21.14:

(1) The addition of medications to peritoneal dialysate.

(2) The administration of chemotherapy.

(3) The refilling of implantable drug delivery systems following placement by a physician in the proper anatomical site.

(4) The administration of intrathecal medications by an externalized ventriculoperitoneal shunt.

(5) Monitoring and administering medications by epidural catheter or other pain relief devices to be used as analgesia for pain control. Administration of medications as used in this paragraph does not include initiation of the medication.

(6) When a physician writes a prescription order for a patient for a specific medication with a range of dosage, the registered nurse shall use professional judgment to determine the amount of medication within the range to be given to the patient.

(c) The following nursing practices fall within the scope of registered nursing practice under § 21.11 and § 21.15 (relating to monitoring, defibrillating and resuscitating):

(1) Measurement of a cardiac output by thermodilution method.

(2) Inflation of a Swan-Ganz catheter balloon for the purpose of obtaining intermittent pulmonary capillary wedge pressure readings.

(3) Establishment of arterial lines with or without a cannula.

(4) Analysis of rhythm strips of patients with permanent programmable pacemakers.

(5) Endotrachael intubation and extubation.

(6) Endotracheal intubation in infant intensive care unit.

(7) Needle aspiration of pneumothorax in infant intensive care unit.

(8) Performance of cardioversion in the presence or absence of a physician.

(9) Umbilical vessel catheterization in infant intensive care units.

(10) Pulling back on Swan-Ganz catheter when it is wedged.

(d) As used in this subsection, ‘‘conscious sedation’’ is defined as a minimally depressed level of consciousness in which the patient retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal commands. The registered nurse who is not a certified registered nurse anesthetist may administer intravenous conscious sedation medications, under § 21.14, during minor therapeutic and diagnostic procedures, when the following conditions exist:

(1) The specific amount of intravenous conscious sedation medications has been ordered in writing by a licensed physician and a licensed physician is physically present in the room during administration.

(2) Written guidelines specifying the intravenous medications that the registered nurse may administer in a particular setting are available to the registered nurse.

(3) Electrocardiogram, blood pressure and oximetry equipment are used for both monitoring and emergency resuscitation purposes pursuant to written guidelines which are provided for minimum patient monitoring. Additional emergency resuscitation equipment is immediately available.

(4) The patient has a patent intravenous access.

(5) The registered nurse involved in direct patient care is certified in advanced cardiac life support (ACLS). Provisions shall be in place for back-up personnel who are experts in airway management, emergency intubation and advanced life support if complications arise.

(6) The registered nurse possesses the knowledge, skills and abilities related to the management of patients receiving intravenous conscious sedation with evaluation of competence on a periodic basis. This includes, but is not limited to, arrhythmia detection, airway management and pharmacologic action of drugs administered. This includes emergency drugs.

(7) The registered nurse managing the care of the patient receiving intravenous conscious sedation medication may not have other responsibilities during the procedure. The registered nurse may not leave the patient unattended or engage in tasks which would compromise continuous monitoring.

(8) The registered nurse monitors the patient until the patient is discharged by a qualified professional authorized to discharge the patient in accordance with established criteria of the facility.

The provisions of this § 21.413 adopted February 20, 1987, effective February 21, 1987, 17 Pa.B. 811; amended June 21, 1991, effective June 22, 1991, 21 Pa.B. 2818; amended January 17, 1992, effective January 18, 1992, 22 Pa.B. 300; amended November 12, 1993, effective November 13, 1993, 23 Pa.B. 5404; amended October 23, 1998, effective October 24, 1998, 28 Pa.B. 5345. Immediately preceding text appears at serial pages (214476) and (222949).