Nurse entrepreneurship Vascular access and PICC services
Nurse entrepreneurship guide
Vascular access and PICC services
Every board document read that addresses RN PICC insertion (Mississippi, Nevada, Connecticut, Kentucky and Massachusetts; South Carolina and New Hampshire by implication) treats it as within RN scope only on conditions: documented education and competency, a provider order and an employer or agency policy, and in some states more. Where a board’s document could not be read, or no position was found, nothing here is permission to insert. The differences are in tip confirmation, LPN roles and what the business itself needs.
Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Last reviewed October 17, 2026. 39 findings: 23 verified, 15 provisional, 1 superseded. 1 time-sensitive, flagged with a recheck date. How findings are sourced and labelled.
1RN insertion by state
Boards read in full for this guide: Mississippi, Nevada, Connecticut, Kentucky, Massachusetts, South Carolina and New Hampshire, plus Texas (no RN-specific statement) and Florida (no position found). Arizona’s document was located but could not be read. Other states are not yet researched.
State by state: compare the states or open the map layers for elective IV hydration, the home-care license and sole-practitioner exemption, RN PICC insertion and NP practice environment.
Mississippi
VerifiedAn appropriately prepared RN may insert, maintain and remove a PICC with training that “should have all components of a formal certification course”, competency documented initially and ongoing, a medical order and agency policies on candidate criteria “especially in the home setting” (Board of Nursing, revised May 1, 2024).
Source: Mississippi Board of Nursing: PICC insertion, maintenance and removal (rev. May 1, 2024)
Nevada
VerifiedA qualified RN with institution-defined training and competency may insert PICCs (basilic, brachial, cephalic and mid-thigh) and CICCs including acute hemodialysis catheters, after prior ultrasound-guided PIV or midline experience and supervised insertions, with an accessible authorized provider (practice decision approved by the Board September 17, 2025).
Corrected 2026-10-18: Dated by its Board approval (September 17, 2025), not October 2025; the midline decision moved to its own finding as proposed.
A Nevada practice decision on peripheral vascular access devices, including midlines, is posted with the footer “Approved by Board: Pending” (proposed and accepted by the Nursing Practice Advisory Committee August 5, 2025). It is a proposal, not an approved decision.
Corrected 2026-10-18: New finding: the midline document was previously described as a 2025 decision; its posted copy shows Board approval pending.
Kentucky
VerifiedAdvisory Opinion Statement #20 (revised February 2025) places insertion of central and midline catheters, “whether peripherally or centrally inserted”, within RN and APRN scope only when its conditions are met, among them institutional policy, a qualified provider’s order, emergency equipment and competent staff immediately available, ultrasound-guided placement, ACLS or PALS and validated tip-confirmation competency. It is written for institutional settings.
Corrected 2026-10-18: New finding: Kentucky was previously listed only for tip confirmation; AOS #20 covers insertion.
Connecticut
VerifiedRNs may insert and remove PICCs, mid-clavicular catheters and midlines on the order of a physician or other authorized practitioner, with substantial IV experience, specialized education, initial validation and annual revalidation (non-binding guidelines, revised 1997).
Recheck on the official site. The guidelines date from 1997; check for a revision.
Source: Connecticut Board of Examiners for Nursing: specialized IV catheter guidelines (rev. 1997)
South Carolina
VerifiedObtaining informed consent for PICC insertion, on the written order of an authorized provider, is within the scope of the performing RN as an expanded role with special education and an organizational policy (Advisory Opinion #65, revised July 2024).
Source: South Carolina Board of Nursing Advisory Opinion #65 (PICC informed consent)
Massachusetts
VerifiedAdvisory Ruling 9301 (revised March 11, 2015) guides RN insertion, management and withdrawal of PICCs: orders written by a duly authorized prescriber, a theoretical and practical formal education program, and organizational policies on competency and informed consent. A trained RN may assess a chest radiograph for tip placement after education overseen by the radiology department, but may not operate fluoroscopy or radiographic equipment; LPNs may not insert or remove PICCs.
Corrected 2026-10-18: New finding: Advisory Ruling 9301 was read in full (it had been reported from a search summary).
New Hampshire
VerifiedThe Board’s RN scope advisories (updated March 9, 2020) list informed consent by the nurse performing a PICC line insertion as within RN scope, which presupposes RN insertion; no PICC-specific conditions are stated beyond the Board’s general advice on education, a written competency plan and yearly review.
Corrected 2026-10-18: New finding: the advisory list was read and its date confirmed; only what it shows is stated.
Source: New Hampshire Board of Nursing: RN scope of practice advisories (updated March 9, 2020)
Arizona: located but not read
ProvisionalArizona has a 2025 advisory opinion on RN insertion and removal of central vascular access devices and arterial catheters; it could not be opened, so its conditions are unknown. It is not a basis to act: read the opinion before any RN inserts a central line in Arizona.
Not yet confirmed — check with the Arizona State Board of Nursing.
Corrected 2026-10-18: Massachusetts and New Hampshire now have their own Verified findings; Florida has its own finding; Arizona is stated as not a basis to act.
Source: Arizona State Board of Nursing: advisory opinion on CVAD and arterial catheter insertion (2025)
Florida: no board position found
VerifiedA 2006 petition asking whether an RN may insert PICCs and assess tip position by X-ray was dismissed on procedural grounds without a ruling: filed January 11, 2006, noticed February 10, 2006, dismissed by an order filed June 22, 2006 as not in substantial compliance with statutory requirements. No Florida Board of Nursing position on RN PICC insertion was found.
Corrected 2026-10-18: Florida’s 2006 petition was dismissed without a ruling; it is no longer described as a pending board document.
Source: Florida Administrative Weekly Vol. 32 No. 6 (Feb 10, 2006): notice of a petition for declaratory statement on RN PICC insertionFlorida Board of Nursing: notice of order dismissing that petition (order filed June 22, 2006)
Texas
VerifiedNo RN-specific PICC position statement appears among the Texas Board of Nursing’s position statements (checked October 2026); Position Statement 15.3 addresses PICCs only to place insertion and removal beyond LVN scope. That absence is not permission. RN scope questions go through the Board’s Scope of Practice Decision-Making Model; that pointer is this guide’s, not a Board statement on PICCs.
Corrected 2026-10-18: Removed an unsupported statement that the Board points to PS 15.28, 15.11 and its decision-making model for PICCs.
Source: Texas Board of Nursing: position statementsTexas Board of Nursing Position Statement 15.3, LVNs engaging in IV therapy, venipuncture or PICC lines (revised 01/2023; reviewed 1/2026)
None of the board documents read (Mississippi, Nevada, Connecticut, Kentucky, Massachusetts, South Carolina, New Hampshire) requires an APRN to insert a PICC. That is a statement about the documents read, not a 50-state check.
Corrected 2026-10-18: Now lists the board documents read, including Kentucky, Massachusetts and New Hampshire.
Source: Mississippi Board of Nursing: PICC insertion, maintenance and removal (rev. May 1, 2024)Nevada State Board of Nursing: practice decision on CVAD insertion (approved by the Board September 17, 2025)Connecticut Board of Examiners for Nursing: specialized IV catheter guidelines (rev. 1997)Kentucky Board of Nursing Advisory Opinion Statement #20: cardiovascular nursing practice (rev. 2/2025)Massachusetts Board of Registration in Nursing: Advisory Ruling 9301, PICC (issued Jan 29, 1993; rev. Mar 11, 2015)South Carolina Board of Nursing Advisory Opinion #65 (PICC informed consent)New Hampshire Board of Nursing: RN scope of practice advisories (updated March 9, 2020)
2Ultrasound, consent and technique
Nevada requires insertion “with ultrasound guidance” under maximum barrier precautions and aseptic non-touch technique; the RN reviews the provider order, assesses the patient and may recommend changes, ensures informed consent and performs a time-out. Documentation includes lidocaine amount, tip position and confirmation method.
Consent is part of the RN’s role
VerifiedNevada and South Carolina build informed consent into the inserting RN’s role, following a provider order.
Source: Nevada State Board of Nursing: practice decision on CVAD insertion (approved by the Board September 17, 2025)South Carolina Board of Nursing Advisory Opinion #65 (PICC informed consent)
3Tip confirmation: X-ray or ECG
Connecticut (1997): “Radiological confirmation of catheter position is required of all [PICC] placements prior to use.” Mississippi (2024): placement verified by X-ray or ECG technology, and “Radiographic confirmation must be by a physician or radiologist.” Nevada (2025): a trained RN may confirm tip placement by intracavitary ECG, Doppler or other approved technology, and may read a chest X-ray for tip position only. Kentucky (2025): a qualified RN may give a preliminary chest X-ray read of tip position, with the radiologist’s final read, or confirm by ECG or ECG/Doppler.
Corrected 2026-10-18: Added Kentucky’s tip-confirmation rule from AOS #20.
Source: Connecticut Board of Examiners for Nursing: specialized IV catheter guidelines (rev. 1997)Mississippi Board of Nursing: PICC insertion, maintenance and removal (rev. May 1, 2024)Nevada State Board of Nursing: practice decision on CVAD insertion (approved by the Board September 17, 2025)Kentucky Board of Nursing Advisory Opinion Statement #20: cardiovascular nursing practice (rev. 2/2025)
FDA-cleared ECG tip confirmation
ProvisionalFDA cleared an ECG-based system (510(k) K140345, 2014) “as an alternative method to chest X-ray and fluoroscopy for PICC tip placement confirmation in adult patients”, with another method needed where the cardiac rhythm alters the P wave (atrial fibrillation, flutter, severe tachycardia, paced rhythms).
Not yet confirmed — check with FDA’s 510(k) database.
Source: FDA 510(k) K140345, ECG tip confirmation (Innolitics mirror)
Kentucky
VerifiedKentucky’s Advisory Opinion Statement #20 lets an RN qualified by specialized education and demonstrated competency verify central venous catheter tip placement with an ECG/Doppler or ECG tip confirmation device, or give a preliminary chest X-ray read for tip position; the radiologist gives the final read.
Corrected 2026-10-18: Now Verified on the full text of AOS #20 (it was previously reported from a summary).
Nevada’s earlier X-ray rule
SupersededAn undated earlier Nevada advisory required X-ray confirmation before any infusion, with a physician’s final read; it appears to be replaced by the CVAD practice decision approved September 17, 2025.
Source: Nevada State Board of Nursing: earlier PICC advisoryNevada State Board of Nursing: practice decision on CVAD insertion (approved by the Board September 17, 2025)
4Orders, devices and drugs
Mississippi: a “medical order”; Connecticut: the order of a physician or other authorized practitioner; Nevada: a “provider order”; Kentucky: a “qualified healthcare provider’s order”; Massachusetts: orders “written by a duly authorized prescriber”; South Carolina: the “written order of an authorized licensed provider”. Who may write it follows each state’s prescriptive-authority law.
Corrected 2026-10-18: The heading no longer says “every board”: it covers the board documents read, now including Kentucky.
Source: Mississippi Board of Nursing: PICC insertion, maintenance and removal (rev. May 1, 2024)Connecticut Board of Examiners for Nursing: specialized IV catheter guidelines (rev. 1997)Nevada State Board of Nursing: practice decision on CVAD insertion (approved by the Board September 17, 2025)Kentucky Board of Nursing Advisory Opinion Statement #20: cardiovascular nursing practice (rev. 2/2025)Massachusetts Board of Registration in Nursing: Advisory Ruling 9301, PICC (issued Jan 29, 1993; rev. Mar 11, 2015)South Carolina Board of Nursing Advisory Opinion #65 (PICC informed consent)
PICCs are prescription devices
ProvisionalPICCs and midlines are Class II devices (21 CFR 880.5970, product code LJS); prescription devices are sold to or on the order of a licensed practitioner. Lidocaine is a prescription drug, which raises state pharmacy questions for a mobile company holding stock.
Not yet confirmed — check with FDA (device classification) and, for lidocaine stock, the state board of pharmacy.
Source: FDA 510(k) K001901, PICC and midline (Innolitics mirror)
Who orders the confirming X-ray
ProvisionalA chest radiograph needs an order from an authorized practitioner; an RN cannot order one independently, so the insertion order usually includes it. Mobile insertion with X-ray confirmation needs a portable X-ray supplier, one reason home programs prefer ECG confirmation.
Not yet confirmed — check with the state board of nursing.
Source: Connecticut Board of Examiners for Nursing: specialized IV catheter guidelines (rev. 1997)FDA 510(k) K140345, ECG tip confirmation (Innolitics mirror)
5Competency and certification
What the boards read require
VerifiedThe board documents read require documented training and competency, not a certification: Mississippi requires training with “all components of a formal certification course”; Connecticut requires annual revalidation. Kentucky requires ultrasound competency and ACLS or PALS. No requirement to hold VA-BC or CRNI was found in the Mississippi, Nevada, Connecticut, Kentucky, Massachusetts, South Carolina or New Hampshire documents. Other states are not yet researched.
Corrected 2026-10-18: Added Kentucky, Massachusetts and New Hampshire to the documents read.
Source: Mississippi Board of Nursing: PICC insertion, maintenance and removal (rev. May 1, 2024)Connecticut Board of Examiners for Nursing: specialized IV catheter guidelines (rev. 1997)Nevada State Board of Nursing: practice decision on CVAD insertion (approved by the Board September 17, 2025)Kentucky Board of Nursing Advisory Opinion Statement #20: cardiovascular nursing practice (rev. 2/2025)Massachusetts Board of Registration in Nursing: Advisory Ruling 9301, PICC (issued Jan 29, 1993; rev. Mar 11, 2015)South Carolina Board of Nursing Advisory Opinion #65 (PICC informed consent)New Hampshire Board of Nursing: RN scope of practice advisories (updated March 9, 2020)
INS Standards of Practice, 9th edition
ProvisionalThe Infusion Nurses Society’s Infusion Therapy Standards of Practice, 9th edition (2024), has 66 standards, adds home infusion therapy, and INS has moved to a three-year revision cycle. Nevada’s 2025 decision tells RNs to follow INS and the Association for Vascular Access.
Not yet confirmed — check with the Infusion Nurses Society.
Time-sensitive. A 10th edition is plausible around 2027.
Source: Wolters Kluwer: Infusion Therapy Standards of Practice, 9th edition (2024)Nevada State Board of Nursing: practice decision on CVAD insertion (approved by the Board September 17, 2025)
VA-BC is voluntary
ProvisionalVA-BC (Vascular Access–Board Certified) is a voluntary credential from the Vascular Access Certification Corporation, open to several disciplines and valid for three years. In practice it is a hospital-credentialing and contract signal.
Not yet confirmed — check with the Vascular Access Certification Corporation.
6LPN and LVN limits
Texas: beyond LVN scope
VerifiedBoard of Nursing Position Statement 15.3 (revised 01/2023; reviewed 1/2026): “it is the Board’s position that insertion and removal of PICC lines or midline catheters is beyond the scope of practice for LVNs.”
Corrected 2026-10-18: Now quotes the position statement itself, which also covers midline catheters, instead of the one-line index summary.
Colorado: no LPN PICC or midline insertion
ProvisionalColorado’s LPN IV rules bar LPNs from inserting PICCs or midlines and from accessing implanted ports; LPNs may flush and change dressings under supervision.
Not yet confirmed — check with the state board of nursing.
Source: 3 CCR 716-1, Chapter 9 (LII)
Advisory Opinion #9B (revised April 2023): selected LPNs may perform central line therapies and procedures under agency policy and with additional training, and central line work requires an RN immediately available on site for supervision, a requirement that “does not apply to PICC lines”. Advisory Opinion #26 covers LPN management of existing arterial lines only. Neither opinion lets an LPN insert a central line.
Corrected 2026-10-18: Added the PICC carve-out in AO #9B and the existing-lines limit in AO #26, cited to the opinions themselves.
Source: South Carolina Board of Nursing Advisory Opinion #9B: LPN peripheral and central IV therapies (rev. April 2023)South Carolina Board of Nursing Advisory Opinion #26: LPN management of existing arterial lines (rev. July 2017)South Carolina Board of Nursing: LPN and invasive devices
Mississippi: removal in the home
VerifiedOnly uncomplicated PICCs may be removed in the home setting (Mississippi Board of Nursing).
Source: Mississippi Board of Nursing: PICC insertion, maintenance and removal (rev. May 1, 2024)
7When a vascular access company needs a license
Inserting lines in patients’ homes is skilled nursing in the residence. Texas exempts one nurse working as a sole practitioner, not a company sending several RNs (HSC §142.003(a)(2)); North Carolina names infusion nursing as a home care service needing an agency license; Florida exempts a nurse acting alone.
Recheck on the official site. Texas was read on a verbatim mirror; confirm on the official site.
Source: HSC §142.003 (public.law mirror)N.C.G.S. §131E-136Fla. Stat. §400.464
Working under a licensed agency or pharmacy
ProvisionalA company inserting lines as a subcontractor to a licensed home health agency or infusion pharmacy may fall under an exemption such as Texas’s one-service contract with a licensee (§142.003(a)(7)); other states’ treatment was not researched.
Not yet confirmed — check with the state licensing agency.
Source: HSC §142.003 (public.law mirror)
Facility-only work
ProvisionalInserting lines under contract inside a hospital, SNF or LTACH usually operates under the facility’s license and contract; the hospital remains responsible for contracted services (42 CFR 482.12(e)). Some states separately license nurse staffing agencies.
Not yet confirmed — check with CMS (the hospital Conditions of Participation); state staffing-agency rules may also apply.
Source: eCFR: 42 CFR 482.12
The company keeps the policies
VerifiedMississippi expects a facility or agency policy holder for home insertions, and Nevada places training and competency on the institution, so a mobile company itself keeps the policies, competency files and quality data.
Source: Mississippi Board of Nursing: PICC insertion, maintenance and removal (rev. May 1, 2024)Nevada State Board of Nursing: practice decision on CVAD insertion (approved by the Board September 17, 2025)
Licensure where the patient is
VerifiedThe compact covers the nurse where it is implemented; Nevada, whose board issued the 2025 CVAD decision, is not a compact state.
Corrected 2026-10-18: Refers to the 2025 CVAD decision only; the midline document is a proposal.
8Billing patterns
All billing points below are provisional: they were not confirmed in CMS or AMA primary text.
The Medicare home infusion therapy benefit
ProvisionalMedicare’s home infusion therapy benefit (effective January 1, 2021) pays qualified suppliers for professional services on infusion days for drugs given through a DME pump; it does not pay for line insertion.
Not yet confirmed — check with CMS.
RNs do not bill Medicare Part B themselves
ProvisionalRNs are not a Medicare Part B billing provider type, so a vascular access company typically invoices the facility under contract, or bills under a physician or NPP group only where incident-to rules are met.
Not yet confirmed — check with CMS and the Medicare Administrative Contractor.
Source: 42 CFR 410.26 (LII)
Procedure codes
ProvisionalPICC insertion codes include 36568–36569 (without imaging) and 36572–36573 (with imaging guidance), 36584 (replacement) and +76937 (ultrasound guidance, not reported with 36572–36573).
Not yet confirmed — check with the AMA (CPT) and CMS.
Recheck on the official site. CPT descriptors are AMA copyright; confirm each code in the current CPT book and the CMS Physician Fee Schedule look-up.
Corrected 2026-10-18: Now cited to the AMA CPT code set and the CMS fee schedule look-up instead of an FDA 510(k) record, which contains no procedure codes.
Source: AMA: CPT (Current Procedural Terminology) code setCMS: Physician Fee Schedule look-up tool (CPT and HCPCS codes)
SNF consolidated billing
ProvisionalIn a covered SNF stay the SNF bills for nearly all resident services; PICC insertion was not confirmed as excluded.
Not yet confirmed — check with CMS.
Source: CMS: SNF consolidated billing
9Safety and quality
Infection prevention
ProvisionalCDC’s intravascular catheter guideline recommends maximal sterile barrier precautions, chlorhexidine-alcohol skin preparation and ultrasound guidance.
Not yet confirmed — check with CDC.
Source: CDC: intravascular catheter-related infection guideline
Bloodborne pathogens
ProvisionalOSHA’s bloodborne pathogens standard applies to the company as an employer.
Not yet confirmed — check with OSHA.
Official sources
- Mississippi Board of Nursing: PICC insertion, maintenance and removal (rev. May 1, 2024)
- Nevada State Board of Nursing: practice decision on CVAD insertion (approved by the Board September 17, 2025)
- Nevada State Board of Nursing: proposed practice decision on peripheral vascular access device insertion (posted copy reads “Approved by Board: Pending”)
- Kentucky Board of Nursing Advisory Opinion Statement #20: cardiovascular nursing practice (rev. 2/2025)
- Connecticut Board of Examiners for Nursing: specialized IV catheter guidelines (rev. 1997)
- South Carolina Board of Nursing Advisory Opinion #65 (PICC informed consent)
- Massachusetts Board of Registration in Nursing: Advisory Ruling 9301, PICC (issued Jan 29, 1993; rev. Mar 11, 2015)
- New Hampshire Board of Nursing: RN scope of practice advisories (updated March 9, 2020)
- Arizona State Board of Nursing: advisory opinion on CVAD and arterial catheter insertion (2025)
- Florida Administrative Weekly Vol. 32 No. 6 (Feb 10, 2006): notice of a petition for declaratory statement on RN PICC insertion
- Florida Board of Nursing: notice of order dismissing that petition (order filed June 22, 2006)
- Texas Board of Nursing: position statements
- Texas Board of Nursing Position Statement 15.3, LVNs engaging in IV therapy, venipuncture or PICC lines (revised 01/2023; reviewed 1/2026)
- FDA 510(k) K140345, ECG tip confirmation (Innolitics mirror)
- Nevada State Board of Nursing: earlier PICC advisory
- FDA 510(k) K001901, PICC and midline (Innolitics mirror)
- Wolters Kluwer: Infusion Therapy Standards of Practice, 9th edition (2024)
- Oley Foundation: vascular access certification
- 3 CCR 716-1, Chapter 9 (LII)
- South Carolina Board of Nursing Advisory Opinion #9B: LPN peripheral and central IV therapies (rev. April 2023)
- South Carolina Board of Nursing Advisory Opinion #26: LPN management of existing arterial lines (rev. July 2017)
- South Carolina Board of Nursing: LPN and invasive devices
- HSC §142.003 (public.law mirror)
- N.C.G.S. §131E-136
- Fla. Stat. §400.464
- eCFR: 42 CFR 482.12
- NCSBN Nurse Licensure Compact map (Aug 2026)
- CMS: home infusion therapy overview
- 42 CFR 410.26 (LII)
- AMA: CPT (Current Procedural Terminology) code set
- CMS: Physician Fee Schedule look-up tool (CPT and HCPCS codes)
- CMS: SNF consolidated billing
- CDC: intravascular catheter-related infection guideline
- eCFR: 29 CFR 1910.1030 (bloodborne pathogens)
Revision history
| Date | Change |
|---|---|
| 2026-10-17 | First published |
About this guide. Published and maintained by Paloma Health Technologies; Findings are cited to official sources, dated and status-labelled; see the editorial policy. Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Questions
Vascular access and PICC services: common questions
Does a nurse need VA-BC or CRNI to insert PICCs?
None of the board documents read for this guide (Mississippi, Nevada, Connecticut, Kentucky, Massachusetts, South Carolina, New Hampshire) requires either; they require documented training and competency. Other states were not researched, and employers and contracts often ask for VA-BC.
Can an RN confirm PICC tip position without an X-ray?
Nevada and Kentucky allow a trained RN to confirm by ECG or Doppler; Mississippi accepts ECG technology but requires a physician or radiologist to read any film; Connecticut’s 1997 guidelines require radiological confirmation.
Can an LVN insert a PICC in Texas?
No. Texas Board of Nursing Position Statement 15.3 places insertion and removal of PICC lines and midline catheters beyond LVN scope.