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Authority to initiate intravenous lines
I’m an RN practising at a wellness clinic where naturopaths offer clients intravenous (IV) chelation therapy. The clinic protocol is for the RN to start the IV and then the naturopath administers the chelation treatment but there is no order in place for a nurse to insert IVs. As an RN, am I permitted to initiate an IV for this therapy?
No, you are not permitted to initiate the insertion of an IV in this situation.
Initiation means a nurse independently decides that a controlled act procedure is required and then performs the procedure without an order. The Authorizing Mechanisms practice guideline lists the procedures that RNs and RPNs can initiate, and outlines the conditions necessary for initiating them.
RNs have the authority to initiate venipuncture to establish peripheral venous access and maintain patency (0.9% NaCl only) when a client requires medical attention and delaying venipuncture is likely to be harmful. Inserting an IV for chelation therapy at the wellness clinic does not fit this description.
Because you cannot initiate the insertion of the IV in this situation, you will need an order to perform it. The order cannot come from a naturopath. The Nursing Act, 1991 lists the practitioners from whom nurses can accept orders for controlled acts; naturopaths are not included on this list.
To facilitate the authority for IV insertion, the wellness clinic team members could work together to create a directive that is authorized by an NP or a physician. For more information on directives, read the Authorizing Mechanisms and Directives practice guidelines.