A Licensed Practical Nurse (LPN), or Licensed Vocational Nurse (LVN) in some states, may or may not be authorized to remove a Peripherally Inserted Central Catheter (PICC line). A PICC line is a central vascular access device: a long, thin tube inserted into a peripheral vein in the arm, with its tip resting in the superior vena cava. LPNs provide direct patient care under the supervision of a Registered Nurse or other licensed healthcare provider. Because central line removal involves potential risks, the procedure’s permissibility depends entirely on the specific state’s Nurse Practice Act and the policies of the employing facility.
Understanding the Clinical Gravity of PICC Line Removal
PICC line removal carries distinct risks, preventing its universal delegation to all nursing staff. The most significant complication is an air embolism, which occurs when air enters the bloodstream through the open insertion site and travels to the heart. To mitigate this, patients are instructed to perform the Valsalva maneuver—bearing down while holding their breath—as the final portion of the catheter is withdrawn.
The nurse must inspect the catheter tip upon removal to ensure its integrity and confirm the full length was extracted. If a portion breaks off and remains inside the patient, it can lead to serious complications, such as cardiac arrhythmias or pulmonary embolism. Resistance during withdrawal, often caused by vasospasm or tissue ingrowth, requires intervention from a physician or advanced practice nurse, as forcing the catheter is contraindicated.
Baseline Limitations of the LPN Scope of Practice
The foundational scope of practice for an LPN centers on providing routine, predictable care for stable patients. LPN education prepares nurses for tasks like administering medications, monitoring vital signs, and performing wound care. This scope is distinct from that of the Registered Nurse (RN), whose practice includes comprehensive patient assessments, formulating nursing diagnoses, and developing care plans.
Procedures involving central access devices, such as PICC lines, often fall outside the typical LPN scope because they require complex assessment and clinical judgment. Managing a PICC line requires recognizing subtle changes in patient status and immediately identifying signs of systemic complications. While LPNs often perform peripheral intravenous (IV) line care, the PICC line’s proximity to the heart elevates the risk profile, leading to greater restrictions on its management and removal.
State-Specific Regulations and Board of Nursing Authority
The definitive answer to whether an LPN can remove a PICC line rests with the State Board of Nursing (BON), which interprets and enforces the Nurse Practice Act (NPA). State regulations create substantial variability across the country and generally fall into three categories:
Explicit Prohibition
In many states, such as Texas and Massachusetts, the BON explicitly rules that PICC line insertion and removal are beyond the legal scope of practice for an LPN. This prohibition is rooted in the high-risk nature of the procedure and the educational difference between LPNs and RNs.
Conditional Authorization
A second group of states allows the procedure under specific, documented conditions, often viewing it as an advanced skill. For instance, in New Hampshire, an LPN may discontinue a PICC line on a stable client provided they have completed an approved IV therapy course and the facility has a policy in place. Florida’s BON recognizes that LPNs can manage central lines, including removal, following a minimum of four hours of specialized instruction and under the direction of an RN or other licensed practitioner.
Delegation by Supervising RN
The third category involves states where the NPA does not explicitly address the procedure, leaving the action subject to delegation by a supervising RN. In this scenario, the RN must determine that the LPN is competent to perform the task and that the patient’s condition is stable and predictable. This ambiguity places a heavy burden of professional responsibility on both the delegating RN and the LPN to ensure the action aligns with established standards of care and the LPN’s individual training.
Facility Protocols and Competency Validation
Even when a State Board of Nursing permits LPNs to remove a PICC line under certain conditions, the healthcare facility’s specific written protocol is the final determinant. Institutional policy often imposes stricter limits than state law; if the state allows the procedure but the hospital prohibits it, the LPN cannot perform the task. These facility protocols standardize care, manage risk, and ensure that only nurses who have demonstrated skill mastery perform the procedure.
Authorization requires the LPN to complete formal didactic training, including instruction on complication management and proper technique. Following classroom instruction, the LPN must undergo practical validation. A qualified Registered Nurse or clinical educator observes and documents the LPN’s ability to safely remove the catheter, apply pressure for hemostasis, and confirm the catheter’s tip integrity, thereby mitigating the risk of air embolism or retained fragments.