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by digger

I am a fairly new nurse that has transferred to a different organization whose policy is to use lidocaine transdermally before perpherial IV insertion. Is this really effective because I have never done this before and it seems like it is more work than it is worth, it seems that risk for infections could be higher with two sticks instead of possibly just one, and the research I've done says that the pain is usually in the patient's head (fear of needles) while other articles say that it really reduces pain. Can anyone help shed light on this issue for me. Is using lidocaine transdermally truely effective or is it just a placebo?

[Dixielee]

Re: Is using lidocaine really effective during venipunture?

Are you talking about injecting lido just under the skin, or topically like EMLA cream? They both have their place, but I rarely use either. I will use EMLA on a kid if I have 30-45 minutes to wait for it to work. I only use lido if the patient requests it. IT is not a placebo because it will numb up the area, but it burns and I think might hurt more than just the stick itself. It also sometimes masks the spot where I have found the vein making it a more difficult stick.

I know a lot of new nurses feel more comfortable using it in case they have to "dig" a little for the vein, but if you are confident in your vein, I say no lido.

If it is policy, you may not have any choice, but I would rather just go without it.

[jmgrn65]

Re: Is using lidocaine really effective during venipunture?

lido does burn I have had IV's started on me with and without, I prefer without. its extra stick and it burns.

[digger]

Re: Is using lidocaine really effective during venipunture?

Thanks for helping out you all!

[PANurseRN1]

Re: Is using lidocaine really effective during venipunture?

I offer it. Some pts. want it, some don't. I had to get used to doing, but now it doesn't affect my success rate.

I think it's really a benefit for pts. who are very apprehensive about IV starts. Buffered lido is better--no burning (and I can attest to this from personal experience).

[palesarah]

Re: Is using lidocaine really effective during venipunture?

Originally Posted by jmgrn65

lido does burn I have had IV's started on me with and without, I prefer without. its extra stick and it burns.

And I'm just the opposite- I prefer with. The "bee sting" of the lido to me is far more tolerable to me than the discomfort of the IV stick, even a stick by the best IV start.

The majority of patients I cared for who had had IVs with and without (this is when I was still working with adult patients who could tell me such, of course) preferred the lido as well- according to both the patients while they were in the hospital and the patient satisfaction surveys they returned after discharge. In fact, hospital policy in one facility was changed to make it mandatory to offer lidocaine or bacteriostatic NS for local before an IV start based on the info from the surveys (before it was hospital policy, it was standard practice in some units, nurse preference in others)

[truern]

Re: Is using lidocaine really effective during venipunture?

If you're starting MY iv, I want lido. I have horrible deep veins so drawing blood or having an iv is a major ordeal

[jmgrn65]

Re: Is using lidocaine really effective during venipunture?

Originally Posted by palesarah

or bacteriostatic NS for local....)

Help me understand How does NS help with the pain of IV stick, especially since ns burns so much. Just asking cause I never heard of that.

[PANurseRN1]

Re: Is using lidocaine really effective during venipunture?

From what I've read, the wheal itself decreases the pain of the stick. There were some studies that showed no difference between lido and NS in terms of making an IV start less painful. There was a long thread in the CRNA forum that discussed this issue in depth.

http://allnurses.com/forums/f16/lido...rt-152733.html

[RemoteRN]

Re: Is using lidocaine really effective during venipunture?

Originally Posted by truesn

If you're starting MY iv, I want lido. I have horrible deep veins so drawing blood or having an iv is a major ordeal

So the phelebotomist puts down lido before drawing your blood?