lidocaine for IV starts?

  1. 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?
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  2. 76 Comments

  3. by   teeituptom
    Its policy here that at the very least we offer Lido to everyone for their IV starts
    I fully reccommend it
    I have had IVs with and with out
    I prefer with

    In fact I wrote the original policy here in our ER for that prob about 15 yrs ago, maybe a bit longer, but there abouts anyway
  4. by   MrsWampthang
    I never use it. I don't see the reasoning for it. Why use two sticks when you can use one and get it over with?

    I've only seen lido used once in all the time I have been in and around ER and that was on my ds when he broke his arm. The nurse, bless her heart, numbed my ds's hand with lido before placing the IV. I don't think it would have made any difference, to me at least. Maybe to him.

    If I am starting an IV, I usually don't have time to numb the site first anyway. My recommendation: don't use it.

    JMHO,
    Pam
  5. by   suzanne4
    If you are allowed to use lidocaine in your dept, USE it. For those of you that have ever needed an 18G started on yourselves, would you want it done without? Sure, if you are putting in a 22G it doesn't really matter. If you are putting in a 20G, ????. But if you need to put an 18G or larger in me for any reason and I am conscious, it better be with a lido chaser. For not having time, that is totally ridiculous. It takes all of one sec to draw up but can make a big difference for the patient. Aren't we supposed to be patient advocates and not cause more pain? Would you want a physician to put sutures in you without lidocaine? "Oh, it is a small needle, you won't feel a thing" :angryfire
  6. by   suzanne4
    If your ER doesn't have a policy for it or doesn't permit it,that is one thing. But for the ones that do and you don't at least offer, that is a crime.
  7. by   thanatos
    I copied this post from a different post on IV starts:

    Try buffering the Lidocaine w/ Bicarb (we call it BiLi), it works great! It numbs the areas immediately around the site w/out the burning sensation. Lido is packaged in an acidic solution in order to provide stability, and that causes the burning sensation. The bicarb raises the pH and thus decreases the pain. I became a believer after the day surgery nurse used it on me...I barely felt the IV (an 18g). I use it w/ good success in the ER on school age children (and certain adults). Ask your pharmacy about it; it's easy to make and stable for about 1 week.

    Also, since you use a very small needle (28 or 30g) for the local infiltration, you can barely feel it.
  8. by   traumaRUs
    I'm a big fan of EMLA which is a topical lido. It does take about 15-20 minutes to be effective. We use it a lot for kids and adults both. Not every stick is an emergency.
  9. by   teeituptom
    here lido with bicarb is called Magicaine isnt that a cute name.
    I know some nurses say it makes it harder to start IVs
    however if the pt is jerking around because of the pain caused I find it easier.

    Now I dont use it in major traumas or those crashing,
    But even those with MIs it only takes a few secs to use before placing those 18g and 16g and even 14g.
    You always have to entertain the Idea its possibly a dissection your dealing with.

    If either the Dr or my discretion says large bore than lido isnt going to hurt a bit
  10. by   purplemania
    Like everything else, once you get used to the method it goes quickly. I would recommend it when feasible. Sure made me feel better when I needed one.
  11. by   MrsWampthang
    When we start IVs we are also drawing blood. We definitely don't have time to wait for EMLA to take effect. I was never taught to use lido with IV starts and have never used it and will never use it. I have been starting IVs for years without it both as a medic and as a nurse. Seems like someone told me once that it makes the veins harder to hit by using lido; I don't know, as I said this old dog's not going to learn a new trick.

    I just don't see the need. It takes all of a second to get an IV unless they are really hard to stick, why poke them an extra time if you don't have to?

    I used to wonder about using EMLA on kids when I was a tech and drawing blood but was told that it took too much time to work, so never pursued it.

    Come on, you're going to tell me that you would use lido to start an IV on an active GI bleeder? Or someone with acute kidney stone pain? Or someone that is in SVT and needs adenocard now? Why take the time? Maybe it is because like I said, I never used it as a medic, was never taught it as a nurse so have never used it and never will. I was always taught to get the IV in on the first try and get it in fast!

    JMHO,
    Pam
  12. by   TennNurse
    I must confess to an embarrassing ignorance here. No place I ever worked or school I ever studied at has ever mentioned this. How is it done? How much do you use? I work in a very small ER, and this could be interesting for all of us at work.
  13. by   Uptoherern
    we were always taught that it can cause vasospasms, making the iv start more difficult.
  14. by   Uptoherern
    as an aside, I always have to remind my dentist to NOT use lido with epi. The epi maes my heart race...........

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