lidocaine for IV starts? - page 3
We are curious if any of you out there use lidocaine to start IV's in the ER? We don't, but often have pt's show up that really get hacked when we don't do that for them. Any thoughts?... Read More
Mar 4, '04Joined: Apr '03; Posts: 7,569; Likes: 2,297I do with kids and nervous adults, or adults who are hard sticks and have been poked multiple times. Nothing tenses them up more than having yet another nurse come at them aiming a needle.
I tell my patients that they have a right to ask for lido for IV starts, and that if the nurse refuses, don't be afraid to insist on a nurse who will do it.
Mar 4, '04Occupation: non-nursing Joined: Nov '03; Posts: 685; Likes: 20I have a hard time getting the IV when using lido so I won't use it, but I always tell my pts who want it, I can get this IV in one stick if you are willing to let me or I can get another nurse to try it with the lido. My feelings are I hate to use something and risk sticking the pt more than neccesary when I could just get it over with quickly, but again I have no prob. asking another nurse with more experience with lido to do the IV start if the pt perfers or if the pt is pulling away and causes me to miss on the first attempt.
Just my 2 cents worth.
Mar 4, '04Joined: Jun '01; Posts: 10,082; Likes: 8,443Having personally been stuck by an anaesthetist 13 times with a 16 gauge (and wishing the whole time for a 12 gauge!) having the option of lido would've been nice. To think, this guy was going to do my epidural... should've known it would be another miss!!!
In the PICU where I work, we may use EMLA without an order, and if the patient is not heavily sedated and/or the IV start isn't emergent, I'll use it. I like that it blanches the skin a bit and makes the veins more visible.
Mar 4, '04Occupation: RN in Prior Authorization for State Sponsored Business Specialty: Emergency room, med/surg, UR/CSR ; Joined: Oct '03; Posts: 706; Likes: 146Quote from traumaRUsWhen I first read this I thought maybe you were 10 to 20 years older than me, then I looked at how old you are....I was born in Oct 59, now, how much younger than you am I? A few months? A year? Don't patronize me, please!Ouch - Pamela - come on girl - times change! I agree that EMLA takes time to work and certainly infiltrating with Lido takes a little time too, but if it leads to better patient care, so what? No - I don't use anything in a crashing patient or a trauma, etc. However, I'm older than you and things can and do change.
Maybe you have been a nurse longer than I have, but I have been starting IVs since 1988, first as an advanced EMT, paramedic, ED tech, and finally as a nurse. I think I have been around the block just a few more times than you think.
As I said before, none of the nurses, medics, doctors, I work with ever even offer patients lido even when docs are doing a femoral stick. New, old, I don't know, but I was never taught to use it, and will never use it. Try sticking someone in the back of a rolling ambulance...you're lucky sometimes to get the IV, forget getting the chance to stick someone with lido first.
We don't use it in our hospital but if you do, more power to you. What works, works, but don't try to tell me I'm wrong by not using lido.
Mar 5, '04Occupation: Labor and delivery RN Joined: Mar '04; Posts: 2I used to use lido all the time when we had "traditional" angiocaths. Over a year ago we changed to the needleless system and since then I missed almost everytime I stated an IV with the new angiocaths and the lido. I guess (at least for me I know it is not so for everyone) the lido does mask the vein and since you can not feel the "pop" with the new angiocaths I had to hang up the lido in order to not have to restick the pt for an IV. Some of the nurses I work with have had the same problem, other have stated that they can not tell a difference. If a patient requests lido I will always get another RN who will use it.
Mar 5, '04Occupation: RN, ICU, CRNA student Joined: Jan '03; Posts: 277; Likes: 2Some people like to do it but what I have found is that if you are good enough then only sticking the person once instead of twice is a whole lot easier for you and the patient. Sometimes it could be good but I never used it
Mar 5, '04Occupation: RN Specialty: ER ; Joined: Apr '03; Posts: 717; Likes: 21i'm a new grad and have worked 7 months in the ER, and i didn't hear about it in school and as far as I know we don't use it in our ER, and we start 18 guage angios all of the time.
so from what i'm understanding it's another stick, i'm gonna ask my charge nurse on wednesday when i see her what she thinks of the deal.
thanks for the idea...... i'd love to see what goes on when i introduce this.
Mar 5, '04Joined: Dec '03; Posts: 37,336; Likes: 5,525Jenni: It is another stick but with a 25G or even 30G needle. It makes it so much more comfortable for the patient and only takes an extra sec of your time. Go down to your pre-op area at your hospital, and see what they are doing. In the OR areas it is a given that your IV will be started with Lidocaine. Why shouldn't it be the same in other areas? Patient comfort should come first, always.
Mar 5, '04Occupation: ER RN Specialty: ER,ICU,L&D,OR,ETC ; Joined: May '01; Posts: 5,588; Likes: 566Well from first hand experience an 18 with lido before is much better than an 18 without lido.
Mar 5, '04Occupation: allnurses Asst Community Manager, APRN Specialty: 25 year(s) of experience in Nephrology, Cardiology, ER, ICU ; From: US ; Joined: Apr '00; Posts: 53,475; Likes: 26,419Pam - I apologize. I too noted the age difference. All I'm saying is that nursing changes, new drugs, new ways of care delivery and we too must change with the times. Also - I too do prehospital care as a pre-hospital RN - it is difficult to start an IV in an ambulance. I live in a rural area and our transport times are up to one hour in the winter. Sorry - if I offended.
Mar 5, '04Occupation: Pre-nursing Student Joined: Jan '04; Posts: 382; Likes: 10Since I am still doing my pre-nursing schedule, I can only respond as a patient who has been on the receiving end.
Having had c-sections, hysterectomy and kidney stones..... I've had IV sticks without Lido in regular hospital or ER setting..... It HURTS! Especially when I was dehydrated.... ouch
I recently had a procedure done in a surgery center and was really dreading the IV. Much to my great surprise and releif, it was absolutely painless! The Rn told me they only use a lidocainmix and they are all virtually painless.
This is something that I will carry with me into my furture nursing practice because it makes a HUGE difference for the patient.
Mar 6, '04Occupation: CRNA Specialty: 45 year(s) of experience ; From: MI, US ; Joined: Nov '03; Posts: 1,685; Likes: 2,213Excuse me - because I was never taught to use lidocaine to start an IV, I never use it? What could come of professional growth if we all displayed this kind of attitude.? I'm a CRNA and very rarely start an IV without lidocaine. I've had nurses practice IV starts on me and they can really hurt on a patient that's already miserable. It only takes a second. Draw up a few in insulin syringes when you're at the lidocaine trough and you'll have them when you need them. We here to treat them, not to torture them. Subee
Mar 6, '04Joined: Apr '03; Posts: 7,569; Likes: 2,297Subee, I agree. I don't always use it but I will if the patient asks or if I think the patient would do better with it, or if I'm starting a large-bore line. I have never met anyone in anesthesia who DIDN'T start one with lido. I've heard many nurses say that if they inject lido first, they miss the stick. I always go in the same puncture and rarely miss.