Lidocaine w/ Epi SQ injections post sheath removal

Charge200J, BSN · Apr 15, 2018

Ooooo that sounds interesting! I've never seen that used before but it sounds like it would make sense. For the average superficial oozy sheath site (no hematoma) we use quik-clot (hemostatic gauze) + pressure dressing and a variety of fem-stop/sand bags/manual pressure, etc...occasionally for the pt in DIC or systemic bleeding/clotting issues we have the doc just toss in an extra stitch if there is a lot of superficial oozing that is hard to control.

Yackinthebox · Sep 6, 2018

Charge200j, we currently do the same. We have also started to inject with lido w/ epi and have had good results for those painful oozing heart cath sites. I was trying to develop a policy for those suborn old fashioned physicians. Any input would be amazing!

offlabel · Sep 7, 2018

So, what's the question, exactly? I'm missing something...

Yackinthebox · Sep 7, 2018

The question is, does anyone have an established protocol for nurses to inject lidocaine w/ epi on ongoing oozy femoral sites(post sheath removal)? I have some physicians that expect this without a call and then I have other(older) physicians that want the "protocol".

offlabel · Sep 11, 2018

Our RN's/techs inject local on every sheath removal, not only ones that meet some criteria (like oozing). If you just attach it to sheath removal and not make it dependent on some condition, it'll be a lot easier.

nursej22, MSN, RN · Sep 19, 2018

We tried to do that, but management decided injecting lido amounted to delivering anesthesia and not covered under the state nurse practice act. They also decided that medicating for pain prior to sheath removal was sedation for procedure, so put a stop to that. So you have to pull the sheath, apply pressure, wait until the patient complains of pain, and then medicate.

offlabel · Sep 19, 2018

We tried to do that, but management decided injecting lido amounted to delivering anesthesia and not covered under the state nurse practice act. They also decided that medicating for pain prior to sheath removal was sedation for procedure, so put a stop to that. So you have to pull the sheath, apply pressure, wait until the patient complains of pain, and then medicate.

If what you say is true of the collective cognitive ability of your "management", it's a wonder that your hospital is still open for business. Unless of course, their job is making RN's job more difficult and someone else runs the actual show...

Do nurses in your system not use lidocaine to place IV's? That's pretty common across the country. And I wouldn't call a skin wheal of local anesthetic "delivering anesthesia". Pretty pathetic.

Sounds like you're hosed...sorry.

applewhitern, BSN, RN · Sep 25, 2018

We cannot use lidocaine to start iv's, Offlabel. Actually, nowhere I've worked have we been allowed to use it. But I agree with you.