4 Colo. Code Regs. § 739-1.18

Current through Register Vol. 47, No. 22, November 25, 2024

Section 4 CCR 739-1.18 - ADMINISTRATION OF INTRAVENOUS FLUIDS

The purpose of this Rule is to clarify the administration of intravenous fluids by a direct-entry midwife to a client in order to restore fluid volume lost due to dehydration, fatigue, or postpartum hemorrhage, as authorized by sections 12-225-107(1), (4)(b), and (5), C.R.S.

A. A direct-entry midwife may obtain and administer intravenous ("IV") fluids only as set forth in this Rule. A direct-entry midwife shall obtain authorized IV fluids only from a Colorado-registered prescription drug outlet, manufacturer, or wholesaler.

B. A direct-entry midwife must receive prior approval from the Director to obtain IV fluids and administer IV therapy. A direct-entry midwife who seeks such approval must:

1. Submit an IV Authority application in a manner approved by the Director and pay the applicable fee; and

2. Satisfactorily complete an intravenous therapy course, within six months prior to submitting an application, that:

a. Is offered by a post-secondary educational institution accredited by an accrediting board recognized by the Council for Higher Education Accreditation of the American Council on Education, is a program or course approved by MEAC", or is a program or course otherwise approved by the Director;

b. Is at least at least six clock hours in length and includes basic principles of the administration of medications intravenously, including the IV fluids listed in paragraph (C) of this Rule; and

c. Includes the following elements:

(1) Basic principles of intravenous therapy, including when to initiate and when to discontinue IV therapy;

(2) Purpose of IV fluid therapy;

(3) Safe infusion and infection control practices;

(4) Equipment;

(5) Appropriate sites;

(6) Procedure and technique;

(7) Rate of administration;

(8) Care of equipment;

(9) Proper disposal of hazardous and other contaminated materials; and

(10) Student demonstration of competence in the ability to administer IV fluids.

3. A direct-entry midwife who does not meet the requirements of subparagraph (2) above may request to demonstrate completion of an equivalent IV course or program to obtain and administer IV fluids. The Director shall consider such a request on a case-specific basis. The decision to approve such a request shall be at the sole discretion of the Director. In considering whether to approve such a request, the Director shall consider public safety and such other factors as the Director deems appropriate. If the Director grants approval under this subparagraph (3) to obtain and administer IV fluids, the Director may subject such approval to lawful conditions the Director finds necessary to protect the public.

C. The preferred drug list of IV fluids a direct-entry midwife may obtain and administer to restore fluid volume lost due to dehydration, fatigue, or postpartum hemorrhage consists of:

1. 0.9% sodium chloride in sterile water (normal saline); and

2. Lactated Ringer's solution (LR).

D. A direct-entry midwife may administer IV fluids only to restore fluid volume lost due to dehydration, fatigue or postpartum hemorrhage. If vital signs are unstable, if blood loss is not controlled, or if client is not responding to IV therapy, transport must be initiated.

E. IV therapy procedures must meet safe and professional standards and must be performed in a manner consistent with generally accepted parameters, including safe infusion and infection control practices consistent with the standards of the Centers for Disease Control and Prevention ("CDC").

F. In order to best serve the needs and ensure the safety of their clients, direct-entry midwives who obtain and administer IV fluids shall maintain competency regarding their use through continuing education and other professional development activities.

G. A direct-entry midwife must be able to supply written documentation, upon request by the Director, which substantiates appropriate training as required by this Rule. Failure to provide written documentation is a violation of this rule, and is prima facie evidence that the direct-entry midwife is not competent and not permitted to obtain or administer IV fluids.

4 CCR 739-1.18

40 CR 12, June 25, 2017, effective 8/1/2017

41 CR 01, January 10, 2018, effective 1/30/2018

43 CR 03, February 10, 2020, effective 1/1/2020

43 CR 07, April 10, 2020, effective 4/30/2020

43 CR 22, November 25, 2020, effective 12/15/2020

44 CR 09, May 10, 2021, effective 5/30/2021

44 CR 20, October 25, 2021, effective 11/14/2021

45 CR 17, September 10, 2022, effective 8/15/2022

45 CR 21, November 10, 2022, effective 11/30/2022