What Can an LPN or LVN Do? IV Therapy, Assessments and Aides in Every State

Most states let an LPN or LVN do IV therapy once they've had the training, keep the comprehensive assessment for the RN, and let the LPN hand tasks to aides. The differences are in the details. A few states keep LPN IV therapy out of the patient's home, the rules on IV push run from a flat no to a yes with conditions, and seven states say only the RN may delegate to an aide.

This article goes through all 50 states and DC: what the nurse practice act, the board's rules and the board's own statements say about IV therapy, assessments, supervising aides and how close the RN has to be. I'm an occupational therapist, not a nurse, so I've stuck to what the rules say and quoted them. For the federal home health side and what LPNs earn per visit, see LPNs and LVNs in home health: scope and pay.

This isn't legal advice. I checked every rule on November 9, 2026, on the state's own legislature, code or board site. Your board's current rule is the one that counts.

The Short Answer

• IV therapy: allowed with conditions in 34. These jurisdictions have a rule, statute or board statement on LPN IV therapy. Nearly all require a course or documented competence first. 14 states have no specific rule. I couldn't verify 3 (New Jersey entirely, and IV therapy in Utah and Wyoming).
• Starting an IV: usually a short peripheral catheter. Every rule that addresses inserting a PICC keeps it for the RN. Iowa's list doesn't include starting an IV at all.
• IV push: 13 say no, 9 say yes with conditions. The other 12 states with IV rules don't name it.
• The home: 4 shut LPN IV therapy out, in whole or in large part. DC, Kansas, Mississippi, and Louisiana through its RN board's delegation rule. Maine and Ohio get close by requiring an RN at the site.
• Assessment: the RN does the comprehensive one. 18 jurisdictions call the LPN's part a "focused assessment" in those words. Most others say the LPN contributes to the assessment or collects data. Alabama is the outlier, under board-approved procedures.
• Aides: 34 let the LPN delegate or assign. Only the RN delegates in Delaware, Hawaii, Illinois, Maine, Utah, Virginia and Wisconsin. Texas and Oregon allow assigning, not delegating.
• Supervision: "direction" is the usual word. Nearly every state puts the LPN under the direction or supervision of an RN, APRN, physician or dentist. Massachusetts says no rule requires an RN to supervise LPNs. Most states don't require the RN on site for routine care.

Every State at a Glance

No specific rule means the act, the rules and the board's published statements I read say nothing specific on that point. Couldn't verify means I couldn't open an official copy. Each citation links to the rule I read, with the source type in parentheses.

Where the Home Comes In

This is the part I'd want to know before taking a home health job as an LPN. Most of these rules were written with a hospital in mind, where an RN is down the hall. A few states say what happens when there isn't one.

• District of Columbia: no LPN IV therapy at home. A practical nurse shall not "Perform intravenous therapy or administer any intravenous medications in home care settings or community based residential care settings." (17 DCMR § 5514.6 (opens in a new tab))
• Mississippi: the same, in different words. "IV therapy as listed in Part 2830, Chapter 2, Rule 2.4 may not be performed by the LPN in the home setting." (Rule 2.4(H) (opens in a new tab))
• Kansas: only the limited scope at home. An LPN shall not do "intravenous fluid therapy in the home health setting, with the exception of the approved scope of practice authorized in subsection (a)." That limited scope is monitoring, "maintaining basic fluids," removing short peripheral catheters and changing their dressings. (K.A.R. 60-16-102 (opens in a new tab))
• Louisiana: the RN board's delegation rule. Among the IV functions an RN may not delegate to an LPN: "in situations where registered nurse supervision is unavailable or limited, such as in home health, the administration of intravenous medications and fluids may not be delegated." In the codified text this clause sits under the item on implanted devices; I've quoted it as written. (La. Admin. Code tit. 46, pt. XLVII, § 3703 (opens in a new tab))
• Maine: an RN in the building. IV authorization "limits the licensed practical nurse to such practice where there is on-site supervision by a registered nurse," and on-site means "the registered nurse is physically present within the facility when intravenous therapy is being administered by the licensed practical nurse." (02-380 CMR ch. 10 (opens in a new tab))
• Ohio: an RN at the site, and an RN assessment first. When an RN directs the IV therapy, "the registered nurse or another registered nurse shall be readily available at the site where the intravenous therapy is performed, and before the licensed practical nurse initiates the intravenous therapy, the registered nurse shall personally perform an on-site assessment of the adult patient who is to receive the intravenous therapy." The looser rule, an RN "on the premises of the home or facility or accessible by some form of telecommunication," covers a "home" as R.C. 3721.10 uses the word: a nursing home or similar facility, not a private house. (R.C. 4723.18(B) (opens in a new tab); R.C. 3721.10 (opens in a new tab))
• Iowa: home care allowed, IV mostly not. In community health settings an RN, ARNP or physician must be in the proximate area, except that "The licensed practical nurse is permitted to provide supportive and restorative care in the home setting under the supervision of a registered nurse or a physician." Iowa's short IV list allows flushes only "in a licensed hospital, a nursing facility or a certified end-stage renal dialysis unit." (Iowa Admin. Code r. 481—620.3(5), (11) (opens in a new tab))
• Oklahoma: a warning to the RN. "Availability of the RN for assessment must be considered by the RN delegating IV therapy to the LPN, such as in home health or hospice, where the RN is not usually immediately available." (OBN guideline P-12 (opens in a new tab))
• Connecticut: an RN within reach. "In community health settings, the registered nurse must be responsible for the total plan of nursing care and should be proximately available for on-site visits and available by telephone." (1989 declaratory ruling (opens in a new tab))
• Alabama: a home health exception. Alabama bans IV push through central lines, but that ban "shall not apply to stable patients with a PICC or midline catheter in a home health setting" when there is an approved standardized procedure, and then "indirect supervision by a registered nurse shall be sufficient." (Ala. Admin. Code r. 610-X-6-.14(6) (opens in a new tab))
• Washington: aides at home are the RN's. "Only the RN may delegate to nursing assistants and home care aides in community-based settings (adult family homes, assisted living facilities, and community residential programs for people with developmental disabilities) and in-home care settings." (Advisory Opinion 13.02 (opens in a new tab))
• Texas: new LVNs in structured settings first. The board recommends "newly licensed LVNs work in structured settings for a period of 12-18 months," and says "if the LVN transitions to unstructured settings where the clinical supervisor may not be on-site, it is the LVN's responsibility to ensure he or she has access to an appropriate clinical supervisor." (Position Statement 15.27 (opens in a new tab))
• California and New York name home care in a permission, not a limit. California counts "home health agencies" among the settings where a certified LVN may start IVs (Bus. & Prof. Code § 2860.5 (opens in a new tab)). New York's board says "New York law requires IV Training for LPNs who provide IV Therapy in hospitals, nursing homes, diagnostic and treatment centers, ambulatory surgery centers, dialysis facilities, home care agencies, and hospice programs," and that LPNs may not give blood transfusions in those settings (Board for Nursing IV guidance (opens in a new tab)).

IV Push, Central Lines and Training

IV push

Thirteen rules or board statements keep IV push from LPNs, apart from flushes, dialysis or emergencies: Arizona, Colorado (injections of five minutes or less), Delaware (an RN-only task), Illinois, Louisiana, Maine, Maryland, Mississippi, Nevada, New York, Ohio, Pennsylvania and South Carolina. South Carolina's board puts it in capitals: "THE LPN MAY NOT GIVE MEDICATIONS DIRECTLY INTO THE VEIN (INTRAVENOUS PUSH) OR INSERT MEDICATION VIA AN EXTERNAL CATHETER SITE." (Advisory Opinion #9B (opens in a new tab))

Nine allow it with conditions:

• Alabama: "Medications may be administered by licensed practical nurses through a peripheral intravenous catheter by intravenous push, provided the following criteria are met," including board approval and an RN in the facility. (r. 610-X-6-.14(4) (opens in a new tab))
• Arkansas: the board's training list includes medications "by intravenous piggyback or intravenous push provided the medication does not require the substantial specialized skill, judgment, and knowledge required in professional nursing." (ASBN IV therapy guidelines (opens in a new tab))
• Kansas: only "in any facility having continuous on-site registered professional nurse supervision." (K.A.R. 60-16-102(b)(9) (opens in a new tab))
• Missouri: IV-certified LPNs with extra employer-verified training. (20 CSR 2200-6.030(6) (opens in a new tab))
• Montana: adults, in listed classes such as analgesics, antiemetics, diuretics and corticosteroids. (ARM 24.159.1010 (opens in a new tab))
• Oklahoma and Texas: left to the employer. Oklahoma's policies must "identify medications that may and may not be administered as IV push (bolus) by the LPN via peripheral or central devices" (OBN guideline P-12 (opens in a new tab)). In Texas it "is up to facility policy" (Position Statement 15.3 (opens in a new tab)).
• South Dakota: with direct supervision, in a licensed health care facility. (ARSD 20:48:04:06 (opens in a new tab))
• Tennessee: peripheral lines, adults over 80 pounds, an INS-based course, and "Licensed Practical Nurses shall not administer IV push medications to pediatric or prenatal obstetrical patients." (Tenn. Comp. R. & Regs. 1000-02-.02 (opens in a new tab))

The other twelve states with IV rules (Alaska, California, DC, Florida, Iowa, Kentucky, Massachusetts, Nebraska, New Hampshire, New Mexico, North Dakota and Washington) don't name IV push. That is silence, not permission.

Central lines and PICCs

Every rule that addresses inserting a PICC keeps it for the RN. Texas: "insertion and removal of PICC lines or midline catheters is beyond the scope of practice for LVNs" (Position Statement 15.3 (opens in a new tab)). Kentucky bans "Initiation and removal of a peripherally inserted central, midclavicular, or midline catheter" (201 KAR 20:490 (opens in a new tab)).

Caring for a central line someone else placed is a different story. Florida says an LPN with four extra hours of training "is capable of performing intravenous therapy via central and PICC lines" (64B9-12.005 (opens in a new tab)), and Delaware, Maine, Maryland, Missouri, Montana, Nevada and South Dakota allow some central line upkeep. At the strict end, New York says "LPNs may not administer IV drugs or solutions through a CAVD" (IV guidance (opens in a new tab)), and Mississippi bars LPNs from administering medications to a central venous line (Rule 2.4(F) (opens in a new tab)).

Training

Most states with IV rules want a course or documented competence before the first stick. A few set hours: Florida's course is "not less than a thirty (30) hour post-graduation level course" (64B9-12.005 (opens in a new tab)), and Kansas wants a course with "at least 30 hours of instruction" plus supervised clinical practice (K.A.R. 60-16-104 (opens in a new tab)). Others leave it to the employer. Oklahoma's board says outright that it "does not approve IV certification courses" (OBN guideline P-12 (opens in a new tab)), and the Texas board says it "does not define or set qualifications" for an IV validation course (Position Statement 15.3 (opens in a new tab)).

Assessment: Focused, Not Comprehensive

No state hands the LPN the comprehensive assessment as part of the basic license. The words vary. Eighteen jurisdictions say "focused assessment" outright. Others say the LPN contributes to, participates in or collects data for the RN's assessment.

• Maryland lists what an LPN may not do, including "Perform the comprehensive nursing assessment" (COMAR 10.27.10.04 (opens in a new tab)).
• Massachusetts: "It is not within an LPN's scope of practice to complete a systematic assessment." (Advisory Ruling 25-01 (opens in a new tab))
• Texas: "The LVN cannot perform independent assessments as the LVN has a directed scope of practice under supervision." (Position Statement 15.27 (opens in a new tab))
• Iowa lets the LPN take part in the initial assessment, but "The registered nurse is responsible for the plan of care, including verifying and interpreting the initial assessment data obtained by the licensed practical nurse." (r. 481—620.3(3) (opens in a new tab))
• Alabama is the outlier. Its rule lists "Completing independent or comprehensive patient assessments of the health status of the patient under approved standardized procedures." (r. 610-X-6-.09(3) (opens in a new tab)) That doesn't change who does the start of care in Medicare home health. The federal rule still says an RN, as the next section shows.

Supervising Aides

Most states let an LPN delegate or assign tasks to aides, usually with an RN somewhere in the chain. Seven say only the RN delegates:

• Delaware: "RNs, not LPNs, may delegate." (24 Del. Admin. Code 1900, 7.5.6.2.1 (opens in a new tab))
• Hawaii: aides work "under the specific delegation and supervision of a registered nurse and not under any licensed practical nurse." (Haw. Admin. R. § 16-89-100 (opens in a new tab))
• Illinois, Maine, Utah, Virginia and Wisconsin write delegation as the RN's act, and Illinois bars an LPN from passing on a task the RN delegated.

Texas splits the difference: "Delegating tasks to unlicensed assistive personnel (UAPs) is beyond the scope of practice for LVNs; however, LVNs may make appropriate assignments to other LVNs and UAPs according to Board Rule 217.11 (2)." (Position Statement 15.27 (opens in a new tab)) Oregon's rule speaks only of the LPN assigning.

Where LPNs may delegate, the limits matter. Ohio allows it "only at the direction of the registered nurse" (Ohio Adm.Code 4723-13-05 (opens in a new tab)). North Carolina requires "continuous availability of a registered nurse for supervision" (21 NCAC 36 .0225 (opens in a new tab)). Kansas's delegation rules cover only schools. And in Washington, the in-home rule above means the RN delegates to home care aides, not the LPN.

How Close the RN Has to Be

Nearly every state puts the LPN under the direction or supervision of an RN, physician or other licensed provider. For routine care, most don't require the RN on site.

• Massachusetts: "There is no regulatory requirement for RNs to supervise LPNs." (Advisory Ruling 25-01 (opens in a new tab))
• Missouri: "such care may be delivered by a licensed practical nurse without direct physical oversight" (RSMo § 335.016(15) (opens in a new tab)).
• Washington: "The RN does not need to be physically present when the LPN provides nursing care or carries out a medical regimen." (Advisory Opinion 13.02 (opens in a new tab))
• Vermont: "Direction may occur via direct supervision or through provider orders, forms, guidelines, policies or procedures, protocols, algorithms, or clearly established plans of care." (Board rules, Rule 6-3 (opens in a new tab))
• South Dakota: in a stable situation, "The supervisor is physically on the premises where the client is being cared for or readily available by electronic communication" (ARSD 20:48:04:01.03 (opens in a new tab)).

IV therapy is where states tighten up. Kentucky lets the supervisor of a stable patient's infusion be "without being physically present in the immediate vicinity of the LPN, but shall be readily available" (201 KAR 20:490 (opens in a new tab)). Maryland allows peripheral IV work "when there is an RN on site or available by telephone" (COMAR 10.27.20.05 (opens in a new tab)). Colorado defines supervision for IV therapy as an RN, physician, dentist or podiatrist who "is physically present or accessible by some form of telecommunication" (3 CCR 716-1, Rule 1.9 (opens in a new tab)). Mississippi, by contrast, allows LPN IV therapy only "if the supervisor is physically on the premises where the patient is having nursing care provided" (Rule 2.4(G) (opens in a new tab)).

The Federal Home Health Rules

Everything above is state law. If you work for a Medicare-certified home health agency, the federal Conditions of Participation sit on top of it, and they don't vary by state. My LPN home health guide covers them in more depth, with pay. The short version:

The RN does the first visit and the comprehensive assessment. 42 CFR 484.55(a)(1): "A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient." Paragraph (b)(2): "Except as provided in paragraph (b)(3) of this section, a registered nurse must complete the comprehensive assessment." Paragraph (b)(3) is the therapy-only exception: "When physical therapy, speech-language pathology, or occupational therapy is the only service ordered by the physician or allowed practitioner, a physical therapist, speech-language pathologist, or occupational therapist may complete the comprehensive assessment." No paragraph names the LPN. (42 CFR 484.55 (opens in a new tab))

The LPN works under an RN. 42 CFR 484.75(c)(1): "Nursing services are provided under the supervision of a registered nurse that meets the requirements of § 484.115(k)." (42 CFR 484.75 (opens in a new tab)) And the personnel rule defines the LPN as someone "licensed in the state where practicing, and who furnishes services under the supervision of a qualified registered nurse." (42 CFR 484.115(e) (opens in a new tab))

Aide supervision belongs to the RN or a therapist. Aides are assigned "by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist)." For a patient getting skilled services, "A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days." For an aide-only patient, "The registered nurse must make an onsite, in person visit every 60 days." (42 CFR 484.80(g), (h) (opens in a new tab))

The one place the federal rule names an LPN with aides is training. The practicum happens "under the direct supervision of a registered nurse, or a licensed practical nurse who is under the supervision of a registered nurse." (42 CFR 484.80(b)(1) (opens in a new tab)) So even in a state that lets LPNs delegate to aides, a Medicare home health agency still needs an RN or therapist for the aide supervisory visits. Our supervisory visit guide covers the 14-day clock, and the home health aide certification guide covers aide training by state.

Key Takeaways

• 34 jurisdictions have a written rule or board statement on LPN IV therapy, and nearly all want a course or documented competence first.
• IV push is the sharpest split: 13 keep it from LPNs, 9 allow it with conditions, 12 don't say.
• In DC, Kansas, Mississippi and (through the RN board) Louisiana, LPN IV therapy at home is shut out in whole or in large part. Maine and Ohio require an RN at the site.
• The RN owns the comprehensive assessment. The LPN does a focused assessment or contributes data. In Medicare home health, federal rules require the RN for start of care regardless of state law.
• Most states let LPNs delegate or assign to aides; seven don't. Federal home health rules still give aide supervisory visits to the RN or a therapist.
• This isn't legal advice. I checked these rules on November 9, 2026, and your board's current rule is the one that counts.

Frequently asked questions

Can an LPN start an IV?

In most states, yes, once the LPN has finished an IV course or shown competence, and usually only a short catheter in a peripheral vein. 34 jurisdictions have a rule or board statement on LPN IV therapy. Iowa's list does not include starting an IV, Ohio limits starts to the hand, forearm and inner elbow, and every rule that addresses inserting a PICC line keeps it for the RN. 14 states have no specific rule, so the decision falls to the board's general scope rules and your employer's policy.

Can an LPN give IV push medications?

It depends on the state. 13 rules or board statements keep IV push from LPNs, apart from flushes or dialysis. 9 allow it with conditions, such as Tennessee (peripheral lines only, adults over 80 pounds, after a course), Kansas (an RN on site at all times) and Texas (left to facility policy). The other states that regulate LPN IV therapy do not name IV push.

Can an LPN do the assessment in home health?

Not the start of care or the comprehensive assessment. Federal home health rules require a registered nurse for the initial assessment visit and the comprehensive assessment, or a therapist on therapy-only cases. State rules agree: 18 jurisdictions describe the LPN's part as a focused assessment, and most others say the LPN contributes to or collects data for the RN's assessment.

Can an LPN supervise CNAs or home health aides?

In most states an LPN may delegate or assign tasks to aides, within limits. In 34 jurisdictions the act or rules allow it. In 7 (Delaware, Hawaii, Illinois, Maine, Utah, Virginia and Wisconsin) only the RN delegates, and Texas and Oregon let the LPN assign but not delegate. In home health, federal rules give aide supervisory visits to a registered nurse or a therapist, not to an LPN.

Does an RN have to be on site to supervise an LPN?

Usually not for routine care. Most states say the LPN works under the direction or supervision of an RN or physician, and several say plainly that the RN does not have to be there, including Massachusetts, Missouri and Washington. The stricter rules are about IV therapy: Maine, Mississippi, Ohio and the District of Columbia want an RN at the site for some or all of it.

Sources

Every state's rule is linked in the table, to the state's legislature, its official administrative code publisher or its board of nursing. All were read on November 9, 2026. Where a board statement is the source, the table says so; board statements explain the board's view of the law but are not the law itself.

• eCFR, 42 CFR 484.55 (opens in a new tab) (comprehensive assessment of patients): paragraphs (a)(1), (b)(2) and (b)(3).
• eCFR, 42 CFR 484.75 (opens in a new tab) (skilled professional services): paragraph (c)(1).
• eCFR, 42 CFR 484.80 (opens in a new tab) (home health aide services): paragraphs (b)(1), (g)(1) and (h).
• eCFR, 42 CFR 484.115 (opens in a new tab) (personnel qualifications): paragraph (e).