Medical orders for lidocaine for IV starts

[bosswheadache]

Hello all. In my conservative state a physician's order is required for an RN to use lidocaine for local anesthesia prior to peripheral IV starts. I have been reading the many posts about nursing advocacy for patients as rational for using the lidocaine. I also recognize the rationale behind those who believe the lidoaine is a second 'poke' thus nonsensical. I believe in applying clinical judgment to each unique patient encounter, so I see the wisdom in each approach. Help me. Do your hospitals have 'preprinted order sets' (or protocols) for RNs to use the lidocaine with IV starts? Ant help would be appreciated. (PS I know states vary in regard to nursing practice statutes. I am interested in how this is handled widely). Thanks in advance!

[Tweety, BSN, RN]

Welcome to Allnurses. Thread moved from "Introductions" to "Genearl Nursing Forum" where you might get more advice.

[jmgrn65, RN]

The use of lidocaine for IV sticks is in our policy for iv sticks, so we have the option of using it. hope this helps

[General E. Speaking, RN, RN]

we do not have a lidocaine policy. If we have exhausted all our means on the floor and ICU or ER has tried, we end up calling anethesia (which they really don't like). They come in with their capes on and save the day. Of course they use lidocaine and usually get the IV. Kinda irritating to hear the compliments about how much it "didn't even hurt when the doctor did it!" I try to explain...

[vamedic4, EMT-P]

Hi Boss...we use lidocaine...but not in the form you describe. We use a cream called EMLA, (Eutectic Mixture of Local Anasthetic) containing lidocaine and other substances, for IV starts when we know our patient is going to go nuts or the parents request it. It is up to us ultimately, however, based on clinical judgement and our patient, as to whether or not we'll use it...but we usually do.

It is placed on the skin over a vein...then covered with a tegaderm or other occlusive dsg. for at least an hour.

Either that or we use Flouri-Methane...a topical anaesthetic that "freezes" the skin prior to the stick.

Working with peds it makes no sense to carry around lidocaine with little needles and stick them twice. I only wish adult facilities did the same thing...my wife's a horrible IV stick and most places only use the injectable lidocaine.

Hope this helps.

vamedic4

One's up...other sleepin'

[HappyNurse2005, RN]

It's a standing order for our labor patients, that we can use lidocaine for iv starts.

[TazziRN, RN]

On the floors an order is needed to use lido, but in the ER and OR it's nurse's discretion. Also, there was an article that recently came out in a medical journal that even the second poke of a lido is beneficial because it reduces the stress of an IV start, which hurts WAY more than epidermal lido. EMLA is great, but ERs don't have time to wait for it to work.

[Antikigirl, ASN, RN]

We don't have a standard order for it, so one day when I wished to use it I actually had to call down to the MD to order it, and have and ER or OR nurse do the IV start with it! Ummmmmm hello, I know how to use it...why all that trouble? Uhgggggggg.

So typically it is so much trouble we don't use it, which is sad for our pts that want it. I will look into that cream, I typically have time to wait for that to work and it would help so much with pt trust and appreciation!

[vamedic4, EMT-P]

EMLA is great, and it numbs the skin up to 2-4 mm deep (per the literature). Be advised that it does have it's drawbacks, mainly...it makes the skin feel "waxy" so if you're a "feeler" like me...it can suck. Also it has a tendency at times to constrict the vein, making palpation more difficult. In the adult population it works very well though.

vamedic4

Not working tonight!!

[nuangel1, BSN, RN]

we don't use it ,we don't have policy for it .iused lot emla when i did dialysis last year but you have the time to wait there.

[ginger58, ASN, RN]

The RN can write an order for "1% lidocaine for IV start per protocol." (CA)

[sister--*]

Ours is a standing order. There are many, many times when it is much appreciated by my patients.