Numbing cream for peds IV's?

sbyramRN · Oct 31, 2009

We used ethyl choloride spray (i work in a pediatric ER). We use LET or EMLA when accessing a port. That does get put on in triage. We know if a Heme/Onc patient comes in with a fever, we will be accessing the port, so that is why it is done. IV's are not as easy to plan ahead on for the EMLA. What happens if you stick and miss and have to go to another site?

RedCell · Oct 31, 2009

I had the "cold spray" myself. I needed a steroid injection in the shoulder, and when I saw that large needle coming at me I was a little concerned:) But I must say, the spray really worked well. Maybe some of you all know the name of it. I wonder if it could be/is used for IV starts or blood draws?

I think you are referring to Chloroethane and it can be used for IV starts and venipunctures. It can also be used to pull off some really funny pranks.

wooh, BSN, RN · Nov 1, 2009

IV's are not as easy to plan ahead on for the EMLA. What happens if you stick and miss and have to go to another site?

You put the EMLA on the likely sites. You're in ER, so of course, both ACs. On the floor, we'll do hands and wrists for IV, ACs for lab draws. (Throw some on the feet if they're young enough.) For the little babies though, we just use sweetease.

I actually kind of hate the EMLA now being required at my facility. It's great a lot of the time. (Although the time I tested it on myself, it didn't work at all for me.) But there's a bunch of kids that all it does is freak them out. You're in scrubs and you're touching them to put the cream on. I think it's better just to freak them out with staff interaction just once for the stick instead of twice for cream then stick. And then there's the age where they know what the cream means, so you've got them freaking out for the hour until it works. Is the pain of a stick really worse than the psychological pain we're causing using it? And our facility has spray, but we're only supposed to use it for emergency IV/lab draws or on request. It supposedly doesn't work as well. And some kids say the cold hurts. Just have to go with what works best for each kid.

sunluvarn · Nov 1, 2009

At the facility where I work (aussie) we use AnGel cream - works better than emla :redpinkhe AnGel vasodilates, and takes MAXIMUM 30 minutes The kids love the look of it and the whole procedure is painless!!!

Editorial Team / Moderator · Nov 1, 2009

In Hematology/Oncology kids that have ports, parents will apply it to the port sites in anticipation before they even come to the hospital.

We do outpatient lab draws in our ED, and we have a 7-year-old kiddo with chronic pancreatitis who comes in from time to time. Her mom puts her EMLA on when she gets there ... but I had to teach her exactly where to put it on her daughter's ACs, because she kept putting it just barely in the right spot -- it was always a little off. Her daughter has gotten used to the blood draws, but definitely appreciates the EMLA. She knows what's coming, so she doesn't get as worked up as other kids.

I saw you mention LMX -- we had a drug rep come speak to our ED fellowship class last year, and we all tried the LMX on ourselves. That stuff seriously worked! We were supposed to get it in all the EDs in our hospital system, but I have yet to see it. I've tried the EMLA on myself, just to see how numb I'd get, and I definitely thought the LMX worked better.

RoyalNurse · Nov 2, 2009

The cream you are thinking about is called EMLA...it is lidocaine based, and there are a few different versions. There are some at my facility that use it on the Peds floor, but not nearly everyone uses it. In the ED, it is available, but almost never used, for a few reasons.
1: It takes time...you're looking at leaving it in place for around 30 min or so to get a somewhat effective result, not always practical.
2: It doesn't always work...lidocaine works, but it's not as effective transdermally.
3: It can make IV's harder...the lidocaine constricts blood vessels, and will sometimes make a viable site more difficult to access.
I don't think it's brutal to not use it, kids learn what the cream is, then they wait for 30 mins in anticipation of an IV stick anyway...I think the stress and anxiety of waiting would be worse, personally. Not to mention, it can decrease the chance of success...leading to multiple sticks. That's worse, too.
My recommendation is, if you're going to use it, is to find several sites, apply the EMLA to more than one site. If you are unable to access one site, you won't have to wait another 30 mins to try again.
By the way, EMTALA is the Emergency Medical Treatment and Active Labor Act, or anti-dumping law. There are EMTALA forms that are filled out to transfer pt.s between facilities, etc. to prevent hospitals from transferring pt.s to other facilities just to get them out of their facility, etc. Just thought I'd share.

:imbar oops, kind of stupid mistake, sorry...

Riley3 · Nov 2, 2009

Lastly, the cold sprays help desensitize the skin as well. I was skeptical as to how effective it was until seeing it used in a Pediatric ER. Works great and there is no waiting.

I worked Oncology for 10 years and we stopped using the cold sprays for ports. There was a study that was done that showed the cold sprays could errode the skin overlying the port. They even sent a picture of what it looked like when it happened. After that we didn't use anymore sprays, but gave a script for emla cream.

LilgirlRN, ADN, RN · Nov 5, 2009

I would never think of using ethyl chloride on a child. It hurts! Will also dissolve styrofoam coffe cups!

Leanne Hardcastle · Nov 5, 2009

The numbing cream is tetracaine 4% (ametop) emla cream is more expensive, so they tend to use ametop