Lidocaine with Rocephin?

[HikingEDRN]

I've been in the ED for almost 3 years. We give Rocephin IM on a fairly regular basis. I have always asked for an order for lidocaine to reconstitute it instead of using sterile water. I was told by more experienced nurses when I started that it decreased the pain associated with the injection.

We have a new doc who is very nice but when I asked him for lidocaine, he looked very surprised and asked me why would we ever want to do that. He said that lidocaine stings on its own and he thought it would make it more painful. No biggie, I used sterile water but what I really want to know is have I been incorrectly advocating for my patients all this time by asking for a lidocaine order? I understand that lidocaine stings when injected but my impression has always been that it helps as the drug absorbs into the muscle.

My caveat is that this is an informal inquiry - I have not researched this subject. Just curious.

[CP2013]

When I was observing in ED during clinicals the nurse said she uses lido mostly if the patient is being docile. But she said she's been spit at and cussed at and she says that if that's the case she mixes with the sterile water because she needs to redirect their focus to why they are here because it has nothing to do with her.

Basically, she doesn't care why you came just be nice to your nurse when you do!

I think she got a little pleasure out if knowing that she caused them discomfort though. Not sure that its ok, but I can understand in my deepest darkest of places.

But if some people say it doesn't matter sensation wise, then maybe it doesn't matter.

And if someone comes in for "a shot and a shake" then I'm using the lido because at least they made me chuckle! :)

I've pretty much always mixed it with lido.. But, many of the nurses I work with tell me I'm too nice, that it would somehow encourage people to be more safe with sex, that they'd remember the burn.

Just gave a Rocephin injection to a young dude with a long history of STDs. When he complained, I said, "Hey man, don't do the crime if you can't do the time" to which he laughed. I then told him about using 18 ga needles and PenV and closed with a few minutes talking about the real nasties like HIV and hepatitis.

It's not going matter a whit, though.

[Nurseadam]

I reconstitute it with NS, we don't carry sterile water vials at my facility..

[amers97]

The MANUFACTURERS recommendations for IM injection diluents for Rocephin are Sterile Water, 0.9% NS, 5% Dextrose, Bacteriostatic water + 0.9% Benzyl Alcohol or 1% Lidocaine solution. So I would go by what the manufacturer recommends. I use the 1% lidocaine at the urgent care I work at and most of the other nurses here do too. We have not ever had an order for the lidocaine because of the recommendation from the manufacture.