A Certified Nursing Assistant (CNA) is an unlicensed healthcare worker who provides direct patient care under the supervision of a licensed nurse. Starting an intravenous (IV) line, known as IV cannulation, involves inserting a needle-catheter device into a patient’s vein to administer fluids, medications, or blood products. This invasive procedure requires specific training and assessment of the patient’s anatomy. Across the healthcare system, CNAs are generally prohibited from initiating IV access.
Scope of Practice Limitations
The primary reason CNAs cannot start IV lines is that this task falls outside their legally defined scope of practice. IV insertion is a specialized, invasive procedure that carries risks requiring advanced knowledge. CNA training typically focuses on activities of daily living and basic patient comfort measures, not complex invasive treatments.
Initiating an IV requires understanding fluid dynamics and anatomy, along with the ability to manage potential complications. Improper insertion can lead to infiltration, where fluid leaks into surrounding tissue, or phlebitis, which is inflammation of the vein wall. Licensed personnel, such as Registered Nurses (RNs) and Licensed Practical Nurses (LPNs), receive extensive education to identify contraindications, select the correct catheter size, and address issues like air embolism or bloodstream infections. Due to the high risk and need for specialized knowledge, IV insertion is reserved for licensed healthcare providers.
Permitted IV-Related Tasks
While CNAs cannot start or administer substances through an IV line, they are instrumental in caring for patients who already have established IV access. Their responsibilities center on observation and support for the licensed nurse. CNAs monitor the IV site for signs of complication, such as swelling, redness, pain, or coolness, which could indicate infiltration or infection.
A CNA must immediately report any observed changes in the IV site or the patient’s condition to the supervising nurse. They also play a role in managing the IV setup by ensuring the tubing is not kinked, which could interrupt the infusion flow. CNAs often assist with patient mobility, managing the IV pole and ensuring movements do not accidentally dislodge the catheter. Accurate documentation of the patient’s fluid intake and output (I&O) is another allowed duty supporting the overall IV fluid management plan.
Role of State Regulatory Boards
The definitive rules governing the scope of practice for Certified Nursing Assistants are established at the state level. Each state maintains a Board of Nursing which interprets and enforces laws outlining what certified and licensed professionals can legally perform. These laws are codified in the state’s Nurse Practice Act (NPA), which protects the public by setting minimum standards for practice and licensure.
The Nurse Practice Act specifically defines the boundaries of CNA certification, including the prohibition against starting IVs. While minor variations exist between states for some tasks, the requirement for licensed nurses to perform invasive procedures like IV initiation is standard. A CNA must know and adhere to the specific regulations enforced by the Board of Nursing in the state where they are employed. The NPA ensures that only individuals who have met the required educational and competency standards perform high-risk procedures.