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!!!

As far as children are concerned, most children are fine, it is the parents who need the Emla.

Total baloney... written by someone with no understanding of local anesthetic pharmacology. Sorry, but this piece of garbage just makes me mad.

I am a HUGE advocate for EMLA cream. Every child deserves EMLA for a planned poke.

0 Votes

Jonear2: I believe you are thinking of Emla cream which does not work at all like an injectable. Depending on the size of the needle and the patient's general mind-set, a wheal of lidocaine may be appreciated. It is injected with a TB syringe, or even an insulin needle as all you want is a tiny bubble.

0 Votes
Whether, it is an 18 or a 24 the pain is the same if done properly.

so you're saying a 24ga hurts just as much as a 14ga?

I think the issue might be the whole ER nurse v. CRNA. In the ER the importance of lido on an adult, even if deemed effective, might be lessened. An ER isn't necessarily about repeat buisness and making the sure the patient has a most pleasant experience, but more so treat and street. A surgical center is all about ensuring a pleasant experience and referrals/repeat buisness. Their line is also not of the urgency that the ER's sometimes is.

I hope that makes sense. Im not trying to start a ER v. anesthesia debate, but the entire goals of the two are very dissimilar. Unless I missed the boat and CRNA's are against local w/ an iv, but from what I've seen its ER RNs. Unless it's contraindicated I couldn't fathom why anesthesia wouldn't work their magic prior to a non-urgent line.

0 Votes
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).

I just had surgery and was saying to a friend the day before...I am more afraid of needles then i am of the surgery. (i had had 5 other surgeries before that though)

0 Votes
Specializes in Anesthesia.
I think the issue might be the whole ER nurse v. CRNA. In the ER the importance of lido on an adult, even if deemed effective, might be lessened. An ER isn't necessarily about repeat buisness and making the sure the patient has a most pleasant experience, but more so treat and street. A surgical center is all about ensuring a pleasant experience and referrals/repeat buisness. Their line is also not of the urgency that the ER's sometimes is.

I was an ER nurse prior to entering anesthesia school and like I stated in my original post, I had never used lidocaine to numb before an IV stick.....nor had I ever seen any of my colleagues do it. However, I agree with my professor and many of the posts on this board about the efficacy of using lido before sticking. I'm sure it is a technique that once I get the hang of, I will use all the time. Thanks to everyone for their replies!!!

0 Votes

We have a policy allowing the numbing, however many nurses do not use it outside of the outpatient surgery area. In my experience (I have had several IV's for surgery, etc), the xylocaine to numb it hurt worse than the actual IV stick. I have used it on patient's that were especially anxious or on patients that requested it. I guess it all comes down to A-- does the institution have a policy and B= te needs of that particular patient

0 Votes
Specializes in Anesthesia.
..........I guess it all comes down to A-- does the institution have a policy and B= te needs of that particular patient

I guess you are forgetting that this is a CRNA forum. Starting their own IVs, CRNAs are not governed by any institutional policy necessarily, but rather by that more universal determinant: what would I want for myself. Some don't, most do.

.

0 Votes

I practiced in an ed for many years, sticking thousands of folks I'm sure, but last yr I needed a gyn procedure done under gen anesthesia and the preop RN used the lido on the dorsum of my hand, as I have poor veins in my forearm. I barely felt the lidocaine stick and did not feel the the larger needle used by the anesthesiologist. It was great! I'm all for it! It did not take but a minute for it to work, certainly not the 30 min someone suggested.

0 Votes

I too would like the literature on lidocaine causing vasoconstriction! Next time I need to put a 14g cath in my pt I will call the infusion therapist above to do it without lidocaine to see how popular he or she becomes with the pt.

0 Votes

when i went to the er as a pacient they didnt numb the area at all and i had to get stuck 9 times and they final got it after a while. but i endored the pain now that i think of it i shouldnt of had to get stuck 9 times i told the er staff my left arm is my good arm for blood draws and iv's .

0 Votes

What no never done that . First off two sticks vs one Id rather have the one that takes a couple of sec and its done And come on an IV isnt that bad I work in a very busy ER and level 1trauma center and never do we use lido.

0 Votes
Specializes in Oncology/Haemetology/HIV.
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.

A person after my own heart.

I am anaphylactically allergy to tylenol. And you really don't want to know (despite large notes on the chart cover and a big medicalert allergy band) how many times people have written and tried to administer products containing it. I have actually had staffers argue that something like percocet or darvocet didn't contain tylenol, as it was a narcotic.

--------------------------------------------------------------------------

Back upon the topic, I received chemo, some of it peripherally, when I was younger. I have been stuck more times than most. And I will ALWAYS decline lido, buffered or not, because it hurts much more than just an IV stick or two. And I don't yank/jerk/or shake during the puncture.

Yet I have had nurses that would, right off the bat, insist that I HAD TO HAVE THE LIDO stick - and didn't understand the word "No". Sorry, but I get stuck enough and don't want it.

-------------------------------------------------------------------------

But this discussion begs a BIG question. If we are lidoing prior to siting and IV to "save the patient" some pain (though, I might debate that), why are we not lidoing prior to each and every stick such as drawing daily labs, IM shots of such painful drugs as visteril, phenergan, etc?

0 Votes
+ Add a Comment