lidocaine for IV starts? - page 4

We are curious if any of you out there use lidocaine to start IV's in the ER? We don't, but often have pt's show up that really get hacked when we don't do that for them. Any thoughts?... Read More

  1. by   OHHNURSE
    Quote from NativeTexan
    We are curious if any of you out there use lidocaine to start IV's in the ER? We don't, but often have pt's show up that really get hacked when we don't do that for them. Any thoughts?

    I worked at Deaconess in OKC for 5 years and their IV team came up with a JAMA article recommending subcute normal saline injection (bleb) for IV insertion. It was proven to be as effective (I can testify to that from my own personal experience with 'naked' IV starts vs using the NS. There will be a small amt of bleeding after the stick (usu in a tuberculin syringe with a 27 ga needle) and you use that little red dot and go back into the same 'hole'. The problem with lido/xylo is that sometimes you could get a bottle with epi accidentally and that will cause HUGE problems with SQ injection.
  2. by   MrsWampthang
    Quote from traumaRUs
    Pam - I apologize. I too noted the age difference. All I'm saying is that nursing changes, new drugs, new ways of care delivery and we too must change with the times. Also - I too do prehospital care as a pre-hospital RN - it is difficult to start an IV in an ambulance. I live in a rural area and our transport times are up to one hour in the winter. Sorry - if I offended.
    Sorry about my reaction. Guess I got up on the wrong side of the bed that day.

    Pam
  3. by   teeituptom
    Unleess Im going golfing anytime I get up otherwise is getting up on the wrong side of the bed
  4. by   Ms.Hobbes
    I work in an outpatient surgery center, plus occasional shifts at our local hospital and that is our standard to use lidocaine before the IV stick. When I first started nursing I was told by many nurses that the use of Lidocaine would make starting your IV more difficult. I have been a nurse for ten years now and have used Lidocaine faithfully now for the last few years and have never really had a problem, just a patient very thankful not to feel the pain of the IV start. I feel if you have the time to start an IV, obviously in an emergency situation you wouldn't, use the lidocaine. I have had IV's started both ways and with Lidocaine is so much nicer. The initial stick with Lidocaine is with such a small needle, the burn from the Lidocaine hurts more.
  5. by   Shotzie
    You've reassurred me Triage Troll. I'd been admiring your responses and was disappointed to see the vehemance of your reaction. But everyone is allowed the priviledge of having a bad moment or a bad day.

    The issue here seems to me that some of us "old timers" may not be used to using the lido for patient comfort. My concern is that as nurses we should not get caught up in the of trap that "it's not the way we do things here".

    I've worked (for a short time then back to a big hospital) in an ER where the status quo was how it was and new thoughts and ideas were met with strong disapproval and negativity. We should always be looking to do our tasks better, more efficiently and be a better advocate to our patients. New ideas should be met with interest, be investigated and implemented if appropriate to your patient population and your center. Sometimes it's hard not to get tired, jaded and burned out but keeping the job interesting will go a long way toward defeating negativity.
  6. by   teeituptom
    Old dogs not only learn new tricks we invent them
  7. by   erjulie
    I've used lido multiple times in Endoscopy, where almost all is elective. No difference in starts, except where the vein is really tiny, then you can have some obliteration. We are going to start using ethyl chloride. remember that? If you do, you've dated yourself. really effective, and fun with kids because there is no stick, just spray, and they LOVE the thought of frozen skin... :chuckle
  8. by   teeituptom
    If you kenw Ethyl
    like I knew ethyl


    anyway one of the EDs was using ethyl on a guys thumb for a subungal hematoma
    He then used a cautery stick to make the hole in the nail
    needless to say there was a big flash
    didnt hurt the pt or the doctor either

    Except the doctor had a prob with stress induced incontinence
  9. by   mazz
    Lido can work well, but it really does make veins disappear. Maybe I was just unlucky to get whatever small percentage of the population that lido does that to, but since that happened, I do not use it anymore.
  10. by   nanseatx
    I was trained by one of the best nurses I ever met in starting IVs and she also used ID NS, stating it was just as effective as lido. All patients that I have used it on agreed that it helped and did not cause the burn that lido does. Each circumstance is different. With some kids and adults, one stick is all you're going to get and I have to make it the one that counts.
  11. by   Iam46yearsold
    Quote from teeituptom
    If you kenw Ethyl
    like I knew ethyl


    anyway one of the EDs was using ethyl on a guys thumb for a subungal hematoma
    He then used a cautery stick to make the hole in the nail
    needless to say there was a big flash
    didnt hurt the pt or the doctor either

    Except the doctor had a prob with stress induced incontinence

    Now that is a strange story
  12. by   suanna
    Our hospital started this as a "nursing order" recently. I'm a little unsure of how they justify the nursing order of a prescription medication (lidocaine)and an invasive proceedure(SQ anesthetic wheal) without additional orders by the physician. I have only seen the order used in the pre-surg area where they frequently start "large bore" IVs and in Oncology when a patient dosen't have a central or PICC line and requires frequent IV restarts.
  13. by   Iam46yearsold
    we do it all the time

    Found in our Policy and Procedures.

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