The question of whether a Licensed Practical Nurse (LPN), or Licensed Vocational Nurse (LVN) in some regions, can change a suprapubic catheter (SPC) is complex. An SPC is a drainage tube inserted directly into the bladder through a small incision in the lower abdomen, offering an alternative to a urethral catheter. This procedure is generally considered more specialized than routine catheter care because it involves manipulating an established surgical tract, which carries risks like tract trauma, bleeding, or misplacement into the abdominal wall. The ability of an LPN to perform this task is not universal and depends on a combination of factors that vary significantly from state to state and facility to facility.
How State Scope of Practice Laws Govern the Procedure
The answer to whether an LPN can change an SPC rests with the laws established by each state’s government, specifically the Nurse Practice Act (NPA). This legislation outlines the legal boundaries for every level of nursing practice within that state. The State Board of Nursing (BON) is the body responsible for interpreting and enforcing the NPA, often issuing specific advisory opinions or rules regarding specialized procedures.
In many jurisdictions, changing an SPC is not included as a basic, entry-level skill within the LPN curriculum, placing it outside the LPN’s independent scope of practice. However, many states permit the procedure if the tract is “established” or “well-healed,” typically meaning it has been in place for several weeks and the initial healing phase is complete. An LPN is almost universally prohibited from replacing a catheter in a “non-established” tract, as this requires advanced clinical judgment to avoid severe complications.
States like Arizona explicitly include SPC changes within the LPN scope of practice, provided the nurse has the appropriate education and training. Conversely, other states categorize this as a higher-risk procedure that must be delegated by a Registered Nurse (RN) or other authorized practitioner. This difference means an LPN in one state may perform the task independently after training, while an LPN in another state must have direct oversight, even for an established tract.
Required Training and Facility Protocols
Even where state law permits an LPN to change an SPC, two practical hurdles must be cleared: individual competency and institutional approval. The LPN must demonstrate specific, documented training and skills validation for the procedure itself. This training goes beyond standard LPN education, focusing on the correct technique for removing the old tube and safely inserting the new catheter into the bladder.
The facility where the LPN works—whether a hospital, long-term care center, or clinic—imposes its own protocols, which can be stricter than state law. A facility may prohibit LPNs from performing SPC changes entirely, regardless of state authorization, due to liability concerns or a desire for standardized practice. Therefore, an LPN must always adhere to the facility’s written policies and procedures, even if the state’s NPA allows the activity.
Facility policies often specify that the LPN must follow clinical practice standards to ensure patient safety. This means the LPN’s training must be current, their skill validated by a qualified observer, and the procedure performed according to a physician’s order. The combination of state law and facility protocol creates the final, enforceable standard of practice for the individual LPN.
The Necessity of Supervision and Delegation
For procedures that fall outside the basic LPN scope, performance is often contingent upon the concept of delegation and supervision. Delegation occurs when a Registered Nurse (RN) or physician transfers the authority to perform a specific nursing task to a competent LPN. This process allows the LPN to execute the task, but the RN or physician retains the ultimate accountability for the patient outcome.
In many scenarios where an LPN is authorized to change an SPC, the task cannot be performed independently. The LPN must work under the direction and supervision of an RN. This supervision ensures that a higher level of clinical judgment is available to manage potential complications, such as difficulty reinserting the catheter or signs of tract injury. The LPN is responsible for accepting the delegated task only if they feel competent and for communicating any issues to the supervising practitioner.