Lidocaine prior to IV start?

penguin2 · Apr 11, 2006

Where I work, in surgery, we start all IV's (except peds) w/local- (anesthesia does too)- it is our policy & has been for as long as I've been there- over 15 yrs. We used to use Lidocaine w/Bicarb mixed by pharmacy- the small amt of bicarb in the lido was supposed to help the burn- we now use buffered lido. We are all expected to do it, & patients love it b/c they don't feel the IV stick. We use a small guage needle (insulin syringe) so it's not like a 20g or 18g needlestick & more comfortable for the patient, esp. if you have any problems getting the vein. However, I do sometimes float to ER also, and they don't use the local. (also, we don't use the local if a 22g IV is used- like for local cases or endo). If I'm the patient having surgery, I'd want the local- most don't even feel the injection.

penguin2 · Apr 11, 2006

hmm. Having had IVs with and without lidocaine, I much prefer to have an IV started with local. I'd prefer the bee sting of lido to the big stick. (Although my new hospital uses buffered lidocaine, so patients are even spared the sting of the lido)
A couple years ago, the hospital policy where I was working at the time changed to be that local anesthetic had to be offered before every IV start. There was a lot of resistance from nursing, especially nurses who had been in the field for many years. One nurse in particular I can think of, who was one of my mentors, had been a nurse for 20+ years and was an excellent IV start. One of the MDAs did an inservice for our department on IV tips & tricks, and she offered herself up as the guinea pig. The MDA started 2 IVs on her, one with and one without lidocaine. She became one for the biggest supporters of, and a resource person for, IV starts using lidocaien after that. Intradermal lidocaine doesn't take any significant amount of time to be effective. It's quick and effective and most importantly, it makes your patient feel like you really care about decreasing their discomfort- I have seen these comments OVER and OVER in patient satisfaction surveys! It's a small thing that makes a big difference.

I totally agree- why should a patient come in- already anxious & immediately have pain inflicted on them?? Especially when IV starts are one of patients' biggest fears!! (it doesn't matter what the surgery is, they deserve to be made as comfortable as possible).

LisaRn21 · Apr 11, 2006

I work in peds and this is not a common practice... There are some kids that we use it on but very rarely do we.

ELMAX acts as a vasoconstrictor and if we are putting it on the site it acctually makes it harder to get an IV in the kids... and when we have babies and such they already have tiny veins I know it sounds evil to enforce the pain... but most times it does more harm than not.

lifeLONGstudent · Apr 11, 2006

Hey, just a thought, but maybe it really didn't have anything to do with "to use Lido or not".... maybe it was "this is how I do it and so therefore THAT IS THE BEST WAY... you need to always do it my way, yada, yada, yada". Otherwise it seems like he/she was making a mountain out of a molehill. If pain were really the issue, don't some meds hurt like crap when they go in, but yet they are still used (frequently)?

just another perspective,

LifeLONGstudent

Just wondering · Apr 11, 2006

Fron the patient's perspective, I think it is a good idea to offer a local, and then respect the patient's wishes.
I've had a number of IV's over the years, for childbirth, surgeries, and ER visits. My veins are like garden hoses, and no-one ever has trouble getting an IV in.
About 10 years ago, I had cancer surgery at the hospital where I worked. Needless to say, it was a stressful time, and I think the anesthiologist (who I knew very well) was trying his best to make things as easy as possible for me. He injected a (very painful) local prior to the IV start, then missed the stick. It took 3 tries to get the IV in. I didn't have the heart to tell him to just do it without the local, so I endured 6 sticks altogether, probably 5 more than necessary. I'll pass on the local in the future!

This was a question to me on this thread.... What happens if you miss and had to look elsewhere to start?....

WVUturtle514 · Apr 11, 2006

This was a question to me on this thread.... What happens if you miss and had to look elsewhere to start?....

This is exactly what my fiance and I were talking about.....I guess using lido is all fine and well if you have a patient with garden hoses for veins and you know you're not going to miss, but what if the patient is a difficult stick and you end up having to stick them more than once?

yoga crna · Apr 11, 2006

I agree 100+% with your instructor. I rarely start an IV without local. A few hints-- I use a 30 gauge needle and buffer the local with sodium bicarb. My patients think I am great and routinely tell me they never felt a thing. All of the RNs in my facility MUST use local if they want to continue working for us.

I am in a boutique practice where the patient having a good, as well as safe ecperience is essential. Obviously, if there is an emergency situation or I restart an IV after induction, I don't use local.

In an elective setting, I haven't seen or heard of one good reason for not using local. In my opinion, it is just laziness. Before you start flining the flack, give me one good reason why not to do it.

A true story--a member of the Board of Nursing in my state had surgery at my facility years ago. An RN tried and failed to start an IV without local. She called a CRNA who, of course used local and started the IV. About a month later the Board of Registered Nursing published a position statement that it was within the scope of practice of an RN to use local prior to starting an IV. The BRN person had strong feelings about the technique.

Yoga

rayman · Apr 11, 2006

Around here rn's don't use a local for starting an iv. My understanding from what I've heard, read and observed is that it is pretty much sop for crna's for just the reason your instructer stated...of course a may be taught differntly in a few months. Every crna that I have ever seen place any sort of line used a local. My $0.02.

NephroBSN, BSN, RN · Apr 11, 2006

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!!!

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.

yoga crna · Apr 11, 2006

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 am very curious about your allergy to lidocaine. True allergies to amide local anesthetics, such as lidocaine are very rare. I did a Medline search and found no references of such an allergy. Could you have had a reaction to the epinephrine in local used in dentistry? Some people get a CNS excitation from an overdose, but this is not an allergy. I would love to have more information.

Never too old to learn new information.

YogaCRNA

susswood · Apr 11, 2006

I started IV's for 4 years in the ER without local.... that makes me shudder now that I know how to do it with anesthesia. In fact, I think it is MEAN to do it without local. It ABSOLUTELY makes a huge difference to use lidocaine. I add a little bicarb.... so stinging is really not an issue. If you use a 30 guage needle... it really makes the whole thing almost painless. If you have good technique, this should not make the IV start more difficult for you.

This is also about ADVOCACY. Think about it..... patients deserve to have any procedure made as comfortable as they can. They shouldn't have to "handle" anything (especially pain-no matter how big or small) if they don't have to.

rayman · Apr 11, 2006

Yoga, you truly are a student at heart. My hats off to you, friend, you set quite an example for us newbies. Your yearn to learn is compelling. I'm always glad to sit at the feet of a master.