Analgesia with IV Start

USA987, MSN, RN, NP · Sep 26, 2005

Our policy is that we can use lidocaine "if the patient requests it or is extremely anxious prior to the IV start".

I work in L&D and I honestly very rarely use it.

ZASHAGALKA, RN · Sep 26, 2005

We have to have an order to use it.

I normally tell patients that, in 13 yrs of nursing, I have discovered that poking holes in people hurts a little. And if I use lidocaine, I'm just going to be poking an additional hole. . .

I would cringe at a policy that makes using it a requirement. It takes long enough to stop and start an IV when you're busy. Why on earth would make it mandatory to draw out the process?

And besides, with many people, it's the anticipation that is stressful. So I'm going to be required to draw out the process and increase that stress?

And some people are stoic about such things. They will say, no, that's ok, just do it. I'm supposed to tell them, no, it's hospital policy to poke 2 holes in you?

I wouldn't make it mandatory. It would just create problems.

Oh, and using NS as an analgesic is disingenuous. I would hate to have to defend that as hospital policy in Court.

~faith,

Timothy

ogrern2002 · Sep 26, 2005

We aren't using NS we are using Bacteriostatic NS, there is a difference, Bacteriostatic has an alcohol preservative that temporarily knocks out the nerve endings locally. However in sufficient amounts the alcohol in the Bacteriostatic can be neurotoxic....that is why you don't use preservative containing drugs in an epidural or with neonates. The other thing is since it is not a "caine" it does not have the sting or electric shock feeling that accompanies the "caines" It is funny I have seen studies, and talked with people in my practice as an IV Nurse, they are having things like Heart Bypasses, Craniotomies, Mastectomies, and they are more scared of the pain of the IV start....I would think as compassionate and caring nurses who's job it is to promote health and alliveiate pain and suffering we would look towards something that might help. Granted it is another poke, but it is like having a TB test....an Intradermal...if done right with good technique..can be virtually painless.

Jolie, BSN · Sep 26, 2005

I had surgery for cancer a number of years ago at the hospital where I worked. Needless to say, it was a stressful time. My anesthesiologist was a compassionate physician who wanted to lessen my discomfort and fear as much as possible. He insisted on using lidocaine prior to my IV start, as he believed it would make the procedure easier to tolerate. The injection of lidocaine was far more uncomfortable to me than the actual IV start would have been. He then missed the first IV he tried, and had to start all over again. I didn't have the heart to ask him to skip the lidocaine the second time, but I would never allow it again. Just my experience.

preciousmofo · Sep 26, 2005

I'm not a fan of the lidocaine for IV sticks. I work in a pre-op area and I start IV's all day and I've never used it prior even though we have a standing order for it's use. And it tends to make veins disappear in my past experience. Time consuming, more sticks.

palesarah · Sep 26, 2005

It's policy for us to use a local anesthetic, we use lidocaine on our floor, but the rest of the hospital uses bacteriostatic NS. A little "bee sting" to avoid the discomfort of an 18gauge IV start is worth it, and 99% of our patients needing IVs agree- especially those who have had IV starts without local in the past. It doesn't take any more time and doesn't "draw out" the process. Our patients appreciate it.

I've had IVs started with and without, and it was much more comfortable having one started with local.

cherricka · Oct 10, 2005

How about using EMLA (lidocaine/prilocaine) cream. I have a patient on kidney dialysis, and she puts in on her AV shunt before she leaves the house, to lessen the pain of accessing it. It works well with no extra needles.

dknunges · Oct 14, 2005

According to INS (Intravenous Nurses Society) local anesthesia should not be used routinely. As far as a policy for infusion therapy to use as a guideline in your institution INS have published Policy and Procedures for Infusion Therapy. You can purchase by going to the INS web site at www. ins1.org. Both the Standards and P&P can seem costly but a good investment. Hope this helps

ghostcat · Oct 14, 2005

How about using EMLA (lidocaine/prilocaine) cream. I have a patient on kidney dialysis, and she puts in on her AV shunt before she leaves the house, to lessen the pain of accessing it. It works well with no extra needles.

EMLA is great - our patients with Portacaths also apply it at home before coming in to have their port accessed. It takes an hour to be effective though, and you have to know exactly where you are going to stick - two things that aren't always practical with PIV's.

As far as the previous comment about lidocaine being discouraged (or however it was worded, I can't remember) I think it is considered too big a risk that it will get accidentally injected in the bloodstream - it has happened! I have used bacteriostatic NS with good results, but most patients whom I have given the choice opt for one stick over two.

Gail-Anne · Oct 24, 2005

A couple articles that you may want to review: (put your medical librarian to work!)

Fein J, Boardman C, Stevenson S, Sibat S; Saline with Benzyl Alcohol as Intradermal Anesthesia for IV Line Placement in Children, Pediatric Emergency Care April 1998

Moureau N, Does it Always Have to Hurt: Premedications for Adults and Children for use with IV Therapy JIN 2000, Vol 23

yoga crna · Nov 9, 2005

I use lidocaine 0.5% (plain) with Na Bicarb (4:1), 30 gauge skin wheal prior to starting every IV. A needle stick with a 30 gauge needle hurts less than an 18 or 20 gauge needle and buffering the local takes away the sting. Try it on yourself if you don't believe me. I have started every IV like this for over 40 years, the patients love it and I insist that all of the RNs who work in my surgical facility do it that way. It is my PERSONAL OPINION that nurses who do not use local to start IVs (in a non-emergency situation) are lazy. Good nursing care is doing what is best for the patient, not what is easiest for you.

Yoga CRNA