Lidocaine prior to IV start?

Specialties CRNA

Published

I am in a front-loaded program and will be starting full-time clinicals in August (thank goodness), but this semester we have had several "observation days." During my last obs day I was with one of my professors who asked me to go ahead and start a peripheral IV on our patient. Well, imagine my surprise when I got reamed a new one for not numbing the patient with lidocaine beforehand. Now, I have been an ER nurse for two years and have started a million IV's and I have never numbed a patient (with the exception of children) before starting an IV. My professor said to me, "We are in the profession of preventing pain, why would you not numb the patient first?" Is numbing the IV site beforehand common practice everywhere or is my professor just being overly anal-retentive? Any comments would be appreciated! Thanks!!!

My "allergy" to lido is the fact that I hate it. I hate that small needle. It hurts and I'm not talking about the lido sting. I think a small needle hurts more than the bigger one.

Well then that's not quite an 'allergy' is it? That's preference and any quality healthcare provider should honor such a request as to not use SQ lidocaine if you so state so.

This falls under the constant allergies I see when doing pre-ops (that the juniors should have done the day before, but that is another story) and at least keeps me smiling throughout the day....

Me: Do you have any food or drug allergies?

Pt: I'm allergic to benadryl.

Me: What does that do to you?

Pt: It makes me sleepy. And I'm allergic to versed. Makes me sleepy also.

Here's the world's best one I've heard yet..

Me: Any allergies?

Pt: I'm allergic to fentanyl.

Me: Are you serious?

Pt: Yes, it gives me diarrhea.

Me: And who told you this?

Pt: Nurse tech did.

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What catheter insertion are you talking about?

Central catheter????

Pretty much all routine IV's are catheters. Very few people use butterflies any more, and even those are available as a catheter.
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It seems I caused some confusion.I ment lidocain jelly with urinary catherter insertion as well as using lido with iv insertion.

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Out of curiousity, rn29306...what were you talking about with the Juniors doing the preops?

And yes, use intradermal Lido with all awake ALs and IVs.

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Out of curiousity, rn29306...what were you talking about with the Juniors doing the preops?

And yes, use intradermal Lido with all awake ALs and IVs.

It was a joke about how our system works. The OR schedule comes out the day before scheduled cases. All-inhouse patients are supposed to be seen by junior students the night before and fill out an anesthesia pre-op form, make sure they are NPO, look at labs, XR, and order any labs or blood products that may be necessary. In our system, seniors run cases without CRNA supervision and we (seniors) run cases well past midnight when on-call. So seniors can't exactly bail on a current case and thus the preops fall on the juniors. Every now and then some preops slip through the cracks and we end up doing them when the pt comes to pre-op holding. Then we give the juniors crap about doing 'their work' but it is all in jest.

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It was a joke about how our system works. The OR schedule comes out the day before scheduled cases. All-inhouse patients are supposed to be seen by junior students the night before and fill out an anesthesia pre-op form, make sure they are NPO, look at labs, XR, and order any labs or blood products that may be necessary. In our system, seniors run cases without CRNA supervision and we (seniors) run cases well past midnight when on-call. So seniors can't exactly bail on a current case and thus the preops fall on the juniors. Every now and then some preops slip through the cracks and we end up doing them when the pt comes to pre-op holding. Then we give the juniors crap about doing 'their work' but it is all in jest.

A JOKE>> You can joke but others can't...Interesting concept.

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A JOKE>> You can joke but others can't...Interesting concept.

I was joking about our anesthesia system functions and the jovial exchanges between junior and senior students as we traverse anesthesia school. I am sorry you cannot comprehend that.

Telling someone you are allergic to something when you really aren't doesn't fall under my definition of joking..

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I was joking about our anesthesia system functions and the jovial exchanges between junior and senior students as we traverse anesthesia school. I am sorry you cannot comprehend that.

Telling someone you are allergic to something when you really aren't doesn't fall under my definition of joking..

I wasn't joking with her. I was protecting myself.. It was a JOKE here............

And giving juniors extra work and treating them as inferior doesn't seem fall under my definition of joking either.

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I wasn't joking with her. I was protecting myself.. It was a JOKE here............

And giving juniors extra work and treating them as inferior doesn't seem fall under my definition of joking either.

Seniors run cases solo. Juniors do some necessary paperwork issues because:

1. they can't do cases solo

2. what do you expect me to do, leave a case I'm currently in and go do it?

Performing a preop assessment is a learning tool that teaches juniors how to evolve from a staff RN to an anesthesia provider. It teaches them to look at a patient from a global standpoint and also intense focus, esp with labs, blood and blood products, radiologic reports, etc. It is not scut work.

No one is giving them extra work, our call shifts are 16 hours regardless. Actually, the juniors get ALL the intubation attempts, PIV sticks (OMG, with lido) and Alines, even if the case is ours. We offer them endless opportunities to advance themselves. Some take advantage, some don't - but the offer is there.

Like I said, I'm sorry if you cannot comprehend this. You are trying to bait me in an attempt as how you view what happened earlier. Ain't gonna happen.

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Seniors run cases solo. Juniors do some necessary paperwork issues because:

1. they can't do cases solo

2. what do you expect me to do, leave a case I'm currently in and go do it?

Performing a preop assessment is a learning tool that teaches juniors how to evolve from a staff RN to an anesthesia provider. It teaches them to look at a patient from a global standpoint and also intense focus, esp with labs, blood and blood products, radiologic reports, etc. It is not scut work.

No one is giving them extra work, our call shifts are 16 hours regardless. Actually, the juniors get ALL the intubation attempts, PIV sticks (OMG, with lido) and Alines, even if the case is ours. We offer them endless opportunities to advance themselves. Some take advantage, some don't - but the offer is there.

Like I said, I'm sorry if you cannot comprehend this. You are trying to bait me in an attempt as how you view what happened earlier. Ain't gonna happen.

But you do chide them that you "had to do their job or was work"

You are trying to bait me it seems . You took this thread and brought up something I said in jest, even using " " to denote that fact, and brought it to another thread.

It still is my RIGHT to list any and every medicine a I care to any way I care to.

I will put you on the list also so you won't have to worry about my impending V-tach.

Just for clarification here I did not use the word scut YOU DID.. Self-fulfilling prophecy.

And since when have RN's stopped looking at a patient globally?

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But you do chide them that you "had to do their job or was work"

Like I said, you won't understand, nor will I explain this any further to you.

It still is my RIGHT to list any and every medicine a I care to any way I care to.

But that doesn't make it an allergy, just your perogative to manipulate things surrounding you.

And since when have RN's stopped looking at a patient globally?

Assuming you are an RN, which I doubt, could you right now approach an in-patient in a Level 1 hospital, usually in a Trauma/SI/CV ICU, with multiple co-existing diseases and acute injuries, metabolic disturbances, and prep this patient for anesthesia? Keep in mind that an anesthesia MD will be coming behind you and checking your sheet and orders, and if you miss something there will be consequences far exceeding senior vs junior joking. I seriously doubt it. That is what teaching someone how to do a preop for anesthesia does. I am sorry if this hurts yours or anyone else's feelings here, but a CRNA or SRNA has much, much more personal responsibility and liability than do staff RNS. Fact of life dear.

This concludes our fireside chat for the evening and any further explanations of twisting the facts of anesthesia school around. We will probably both be booted from this forum in the morning anyway.

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Just for clarification here I did not use the word scut YOU DID.. Self-fulfilling prophecy.

And I said doing pre-ops was not scut work. It is a useful teaching device.

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