lidocaine for IV starts? - page 6

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   Dolce
    I do work Same Day Surgery, so it isn't a good comparison to the ER. But, I will say that it takes maybe 5 seconds longer to put in the lidocaine and the patients appreciate it so much. Most of them do not even feel the stick. We use 18 gauges almost exclusively so these are big IVs that we have to get in and they do hurt. I don't like it when nurses ask patients, "Do you want 1 stick or 2 sticks." A 27 gauge TB syringe is way, way different than a 16 or 18 gauge angiocath. Yes, the vein does get obliterated with the bleb but its still easy to hit.
  2. by   truern
    I'm a VERY hard stick and if you're coming at me with an 18g IV you'd better have some lido in your other hand!!
  3. by   TraumaNurseRN
    Quote from RiderRN
    Screw the Lido! We work in the ED not the freeking PACU or Same Day Surg. Our patients are here because they are SICK, and have life threatening issues that need urgent interventions. Lido is a luxury, not a necessity. If you are sick enough for an IV, say you are dehydrated, vomiting, having terrible pain that an IM/PO med isn't enough, then you can have an 18g to better and more quickly hydrate you, or what if your terrible pain is related to your appendix rupturing and you need to go to the OR? That OR staff will appreciate the 18g over a 22g. And for all those patients with 10/10 pain, what's a IV start next to your 10/10 migrane that you've had for the past three weeks, and yesterday it took 8mgs of Dilaudid to help? Come on people, I'm not trying to be uncompassionate, I was recently hospitalized and in the ED, and fabulous nurse inserted a 20g in my R wrist, and YES it hurt! I remember feeling the shooting pain, looking down and asking if she put an 18g in! But, it was over fast, and she and I were on our ways,... This is ED people! And for kids, why would you prolong the situation???? I've always felt that with kids you go in, and go out, as fast as possible. Get everything done in one fell swoop. So why would you torture them for the lido, then plead with them that they then won't feel anything? No! You are honest with them, YES it will be a little owie, but it will be over quickly, and you deliver. Lido prolongs the discomfort, makes the sight edematous and takes too long.
    I so agree!!!! Someone comes in having an acute MI...shoot....we need two large bore IVs when they go to the heart cath lab....working for a 20minute door to balloon....no lido....it's the ER
  4. by   SDS_RN
    Where I work most pts are clinical -not emergent. Yes if they are critical of course there is no time for lido-- but if time warrants it why not?
  5. by   TraumaNurseRN
    Quote from SDS_RN
    Where I work most pts are clinical -not emergent. Yes if they are critical of course there is no time for lido-- but if time warrants it why not?
    It's not in our policy. Plus....we're not allowed to have meds on us or in our pocket. We have the pyxis system and they would have to purchase huge amounts of lido and not to mention the storage issue. We have a 65 bed ED Level II Adult and Pediatric Trauma Center. Huge amounts of lido would be needed.
  6. by   bill4745
    Having just spent 30 days in the hospital and probably having 25 iv starts, it's one thing to have 22 or 20 in the forearm. A 20 in the back of the hand is a differrent story, and a few minutes drawing up and giving the lido was much appreciated. The savings in time due to the ease with which the line went in made up for the time spent on the lido.
  7. by   TraumaNurseRN
    Quote from bill4745
    Having just spent 30 days in the hospital and probably having 25 iv starts, it's one thing to have 22 or 20 in the forearm. A 20 in the back of the hand is a differrent story, and a few minutes drawing up and giving the lido was much appreciated. The savings in time due to the ease with which the line went in made up for the time spent on the lido.
    wow that many IV starts....
  8. by   NotReady4PrimeTime
    Quote from TraumaNurseRN
    wow that many IV starts....
    I had 14 attempts in the same night back in 1981. The first IV, put in by my GP, was a 20, and the anesthetist who was going to do my epidural didn't like it, said it wasn't big enough if he had to push fluids, so he took it out. THEN he started trying to place another one. After 12 failed attempts on both forearms and ACs (with 16!!) he gave in and put an 18 in the back of my left hand. He said he had wanted to leave my hands free because I was planning to breastfeed after my C-section. And then he missed the epidural.
  9. by   emmycRN
    I recently started a new job in a department where using lido is the policy. I can tell you that it makes a big difference because my patients always tell me it was the best IV stick they've ever had. I think it actually make the stick easier becuase if you have to "look" for the vein with the needle the patient doesn't feel a thing.
  10. by   Iam46yearsold
    I agree, Lido is the best and easiest way.
  11. by   swsh10
    I think its a case -to- case basis; if it's an emergency, or if a pt is in a lot of pain or distress, I don't gather they'd care one way or another. In our pre-op area, I usually give the pt a choice, and warn them beforehand that if they were a difficult start and I used lido, I may not see their veins anymore. (I'm good at just doing it one time) . I think the method in IV starting is more important - for instance I take time in finding the vein most appropriate for the procedure; if I do not see or feel a vein, I look for a second opinion / I do jot dig for the vein (which some nurses I observed do, therein I think lies the reason for pain). Some of my pts like lido, some don't. This is an interesting thread, particularly the info on ID NS and lido buffered with bicarb - learned something new. I've had a few pts come in with emla cream already applied on the sites they think the IV is going onto. We used to have the ethyl chloride spray (which worked wonders), but our hosp phased it out because one of the surgeons claimed it was causing thermal burns on some of his pts (any thoughts on that?).
  12. by   swsh10
    And oh, I've also had a few pts with mediports who request lido ID over the mediport site before I access their sites (they have it done at the Dr's offices). Any comments on this as well?

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