Lidocaine prior to IV start?

Specialties CRNA

Published

I am in a front-loaded program and will be starting full-time clinicals in August (thank goodness), but this semester we have had several "observation days." During my last obs day I was with one of my professors who asked me to go ahead and start a peripheral IV on our patient. Well, imagine my surprise when I got reamed a new one for not numbing the patient with lidocaine beforehand. Now, I have been an ER nurse for two years and have started a million IV's and I have never numbed a patient (with the exception of children) before starting an IV. My professor said to me, "We are in the profession of preventing pain, why would you not numb the patient first?" Is numbing the IV site beforehand common practice everywhere or is my professor just being overly anal-retentive? Any comments would be appreciated! Thanks!!!

Jeez...don't know what's with the banter between you two regarding this simple question. I was asking rn29360 about the dynamics of her program, simply as a comparison to others...mine. None the less...moving on...thanks for the original explanation.

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Like I said, you won't understand, nor will I explain this any further to you.

But that doesn't make it an allergy, just your perogative to manipulate things surrounding you.

Assuming you are an RN, which I doubt, could you right now approach an in-patient in a Level 1 hospital, usually in a Trauma/SI/CV ICU, with multiple co-existing diseases and acute injuries, metabolic disturbances, and prep this patient for anesthesia? Keep in mind that an anesthesia MD will be coming behind you and checking your sheet and orders, and if you miss something there will be consequences far exceeding senior vs junior joking. I seriously doubt it. That is what teaching someone how to do a preop for anesthesia does. I am sorry if this hurts yours or anyone else's feelings here, but a CRNA or SRNA has much, much more personal responsibility and liability than do staff RNS. Fact of life dear.

This concludes our fireside chat for the evening and any further explanations of twisting the facts of anesthesia school around. We will probably both be booted from this forum in the morning anyway.

Isn't one of the requirements for attending CRNA school one year of critical care nursing? Do critical care nurses not look at labs, etc as you so carefully explained. If that is the case then NO I don't qualify.

As far as being a nurse. I will overlook your attack on me in that department. I guess you don't know what BSN stands for. I've been a nurse almost as long as you have been alive.

As Richard Pryor used to say.. "When I go into the woods to get the switch for you to beat me with I hope it meets with your approval"

Besides I chose my field of practice early on. I like my patients awake so they can TELL me what hurts and what doesn't.

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And I said doing pre-ops was not scut work. It is a useful teaching device.

But you did use the word scut.. Freudian slip????????

And a two-fer.. Wow for someone who wasn't gonna dig anymore.....Oh nevermind

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Jeez...don't know what's with the banter between you two regarding this simple question. I was asking rn29360 about the dynamics of her program, simply as a comparison to others...mine. None the less...moving on...thanks for the original explanation.

I DO know what banter is. The other poster seems to know in only in context of their own posts. That was my point...

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Seniors run cases solo. Juniors do some necessary paperwork issues because:

1. they can't do cases solo

2. what do you expect me to do, leave a case I'm currently in and go do it?

Performing a preop assessment is a learning tool that teaches juniors how to evolve from a staff RN to an anesthesia provider. It teaches them to look at a patient from a global standpoint and also intense focus, esp with labs, blood and blood products, radiologic reports, etc. It is not scut work.

No one is giving them extra work, our call shifts are 16 hours regardless. Actually, the juniors get ALL the intubation attempts, PIV sticks (OMG, with lido) and Alines, even if the case is ours. We offer them endless opportunities to advance themselves. Some take advantage, some don't - but the offer is there.

Like I said, I'm sorry if you cannot comprehend this. You are trying to bait me in an attempt as how you view what happened earlier. Ain't gonna happen.

Sounds like great learning opportunities!

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Thank you sir may I have another?:lol2:

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I had my first IV insertion yesterday by a CRNA. No lido. But it didn't hurt much at all and she got it on the first stick and complimented my veins. Only another nurse would be happy about that eh?

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I'm new to this site and I have read all the messages in this thread--with feelings ranging from incredulity to exasperation. After 30 years of practice as a CRNA, much of which involved anesthesia student education, I can sya I have never had a patient notbe grateful for the pain and stress relief afforded by the properly carried out raising of an intradermal wheal with a 25-30ga needle and xylocaine prior to IV insertion. The key words here are "properly carried out". Many nurses never took the time or had the opportunity to learn to do this properly---the exception has always been the CRNA. We are taught to focus on the relief of suffering and anxiety in even the smallest of ways during the anesthesia experience. Most patients can bear the pain of IV placement with very large needles, but why should they have to do so? The more pain experienced by the patient prior to the induction of anesthesia, the more stress-induced physiological changes the anesthetist must deal with while trying the establish maintenance phase anesthesia. Comparing what we take the time to do with what other organizations choose to do (Red Cross, etc.) isn't an appropriate way to establish the standard of care for anesthetists--we're supposed to be the pros in pain and anxiety management for the patient--the preoperative phase should not be an endurance process, but a chance for the demonstration of caring even in the smallest things, like making an IV stick less stressful. My suggestion is that the original writer of the question learn to do the procedure well and see how many of her/his patients are appreciative of the time and effort spent to make them know they are being taken care of by the best.

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I like my patients awake so they can TELL me what hurts and what doesn't.

My patients don't need to be awake to let me know what hurts.

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Specializes in PeriAnesthesia.

Until recently, only the perioperative areas in my facility were able to use Lido for IV starts (an MD order was required). Our Day Surgery undertook a research study on the effectiveness of subQ lido vs 0.9% bacteriostatic normal saline for "numbing" for IV starts. The data supported the use of Bacteriostatic saline and the practice has now been expanded to the entire facility. It's written as a protocol so that all RNs can use it and no MD order is required. If you are interested in their data it was published in JOPAN (see below).

A comparison of bacteriostatic Normal Saline and Lidocaine used as interdermal anesthesia for the placement of intravenous lines

Kwan M, Windle PE, Warwick H, Sibayan A, Espiritu C, Vergara J

Journal of PeriAnesthesia Nursing

August 2004 (Vol. 19, Issue 4, Page 267)

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At the hospital I used to work at we nurses on M/S never used lido. The ACU did. So if a surgical patient came to us they had lido before surgery and if we had to restart they didn't. Never heard any complaints.

I was a surgical patient twice in that hospital and both times I told the ACU nurse I was allergic to lido. And yet she brought over the lido any way. I had worked in ACU for awhile and knew that they drew up all their lido syringes at the beginning of the shift at 0530... She managed to miss the anticub.The same anticub I use for giving blood. Never had a problem with it before. I give blood 2-3 times a year.

Then another nurse came without lido and got the vein on the thumb side of my wrist without difficulty.

IMHO lido gets in the way. You can't find the vein as easily.

If your hospital uses lido all the time you better be asking if your patient is allergic to lido.

Good luck.

I have to support the previous comment by YogaCRNA. I am interested in your "allergy" to xylocaine. I agree that true allergies are associated with the ester agents not the amides, such as xylocaine. From further reading of responses,I see that you really said you were allergc in order to control a situation you did not like. Not a good strategy, even as a joke, to give misleading medical information. As a nurse you know that the patient always has the right to refuse treatment, so all you needed to do was refuse the lidocaine rather than create a situation that could have had an impact on your intraoperative care.

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I have to support the previous comment by YogaCRNA. I am interested in your "allergy" to xylocaine. I agree that true allergies are associated with the ester agents not the amides, such as xylocaine. From further reading of responses,I see that you really said you were allergc in order to control a situation you did not like. Not a good strategy, even as a joke, to give misleading medical information. As a nurse you know that the patient always has the right to refuse treatment, so all you needed to do was refuse the lidocaine rather than create a situation that could have had an impact on your intraoperative care.

I'm glad you put allergy in " ".. It was a joke in the original post in another thread..

First of all I knew the nurse who was starting my IV

Secondly I told her THREE times I didn't want lido.

Thirdly she told me she used LIDO so if she couldn't hit the vein it allowed her to "dig"

The lido in that ACU is all drawn up at the beginning of the shift. It wasn't buffered.

I used "allergy" FINALLY to get her to stop trying to sneak it into my arm.

She asked me on her third attempt to use it why I didn't want it. I told her I was allergic to it.. It was the only way to get out of having it.

My issue with all this is the fact that nurses are treating every patient the same..

Patient's have rights and if we have to go to extremes that's our perogative too

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