lidocaine for IV starts? - page 5
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
Nov 8, '08Joined: Nov '07; Posts: 487; Likes: 581Quote from subeeWe don't use the lido for IV starts, nor would we be allowed to draw up lido in syringes and carry them around with us. Sorry, but I disagree, if the patient needs an IV, I do not consider that torture....Excuse 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
Nov 8, '08Joined: Dec '03; Posts: 100; Likes: 77I've found that using lidocaine increases my rate of missed IV's. Without it, I can get in virtually the first time every time (except for those "everyone has a bad day" type of days). If I use lidocaine, it's almost a guarantee I'll have to stick you again because I feel it displaces the vein or causes some type of irritation to increase irritability in the vein which them causes it to spasm.
Maybe it's all in my head, but I much prefer to start without - quicker, one stick, and therapy initiated faster. This is not torture but providing fast, competent, professional care to my patient.
Nov 8, '08Joined: Nov '05; Posts: 485; Likes: 269TraumaNurseRN,
As usual I couldn't agree with you more. It is an ER, if it is such an emergency than SUCK IT UP and take the 2 second IV stick. And if you ask me to "numb it up", I'm just going to go from a 20g to an 18.
Nov 9, '08Occupation: Critical Care Transport Nurse and Paramedic Specialty: ICU and EMS ; From: US ; Joined: Mar '07; Posts: 257; Likes: 650I'm interested in hearing more about using normal saline. I'm an ER tech, so I know that I would never be allowed to use lido. I've not heard of using either NS or lido for IV starts-- both from the hospital and in nursing school. Do you still use 0.1ml? Do you go directly over the vein, or more to one side? Sometimes the vein that I'm targeting is very superficial, and I wouldn't want to accidently hit the vein and blow it with the initial needle. Also, those of you who do use NS-- do the techs use it as well?
Nov 11, '08Joined: Jul '07; Posts: 2,251; Likes: 8,238Old post alert! This started in 2004 so you might not get responses from some of the posters. The information, however is still timely. Also wanted to point out that drawing up meds ahead of time and either carrying them around in your pocket or having them at your workstation is a HUGE and expensive JCAOH violation! This includes saline, even the pre-packaged kind. There are, of course, some area that are exempt from this but the ER isn't one of them.
Nov 12, '08Joined: Jun '06; Posts: 819; Likes: 335in 22 years of nursing i have never used lido for iv start .never found the need .get my ivs in 1 shot .and i personally have had ivs placed 18 20 and 22 .during 4 hospitalizations .its not a big deal.i have worked 5 ers and have never had a policy of using lido for stick certainly couldn't carry the lido in pocket .jacho violation and unsafe .the only time i have used emla or lido is when i worked dialysis used 14-17 gauge needles.
Nov 12, '08Occupation: Paramedic Specialty: 23 year(s) of experience in EMS, Peds Cardiology, ER, PICU, IV Jedi ; From: US ; Joined: Jul '05; Posts: 1,083; Likes: 466I've started literally thousands of IVs. Lidocaine is great, and if it's available to you..give it a try. My hospital utilizes a new form of the lido..in a J Tip. It is a syringe with .3cc of lidocaine and it is injected through the skin via compressed air - there is no needle...the force of the carbon dioxide pushes the lidocaine into the skin. It forms a small bleb and bleeds just slightly but after 15 seconds you can put an 18 or 16 in them and they won't feel it. I'd pull up a link but my computer is going haywire at 0440.
Have a great day.
Nov 12, '08Joined: Nov '05; Posts: 485; Likes: 269Quote from EMSnut45What state do you live in that ER Techs can start IVs, or are you an EMT-I or something?I'm interested in hearing more about using normal saline. I'm an ER tech, so I know that I would never be allowed to use lido. I've not heard of using either NS or lido for IV starts-- both from the hospital and in nursing school. Do you still use 0.1ml? Do you go directly over the vein, or more to one side? Sometimes the vein that I'm targeting is very superficial, and I wouldn't want to accidently hit the vein and blow it with the initial needle. Also, those of you who do use NS-- do the techs use it as well?
Nov 13, '08Joined: Feb '08; Posts: 7; Likes: 2Screw the Lido! We work in the ED not the freeking PACU or Same Day Surg. Our patients are here because they are SICK, and have life threatening issues that need urgent interventions. Lido is a luxury, not a necessity. If you are sick enough for an IV, say you are dehydrated, vomiting, having terrible pain that an IM/PO med isn't enough, then you can have an 18g to better and more quickly hydrate you, or what if your terrible pain is related to your appendix rupturing and you need to go to the OR? That OR staff will appreciate the 18g over a 22g. And for all those patients with 10/10 pain, what's a IV start next to your 10/10 migrane that you've had for the past three weeks, and yesterday it took 8mgs of Dilaudid to help? Come on people, I'm not trying to be uncompassionate, I was recently hospitalized and in the ED, and fabulous nurse inserted a 20g in my R wrist, and YES it hurt! I remember feeling the shooting pain, looking down and asking if she put an 18g in! But, it was over fast, and she and I were on our ways,... This is ED people! And for kids, why would you prolong the situation???? I've always felt that with kids you go in, and go out, as fast as possible. Get everything done in one fell swoop. So why would you torture them for the lido, then plead with them that they then won't feel anything? No! You are honest with them, YES it will be a little owie, but it will be over quickly, and you deliver. Lido prolongs the discomfort, makes the sight edematous and takes too long.
Nov 14, '08Occupation: RN Specialty: 10 year(s) of experience in Emergency, ICU ; From: US ; Joined: Aug '07; Posts: 850; Likes: 1,719I don't know... I wonder if technique is really the thing to perfect.
I am a complete needlephobe, so when sticking someone, I am very aware of their pain. I do it quick but gentle and usually in 1 stick.
Most of my patients comment that they didn't feel the stick at all, especially if they've had IV's inserted before and can compare.
I had never heard of using a lido prep and it's not a policy where I work so I wouldn't have a chance to try it. Also, I don't know that I'd want to stick the person twice and increase chances for skin breaks and infection.
Anyway, I do believe that if you are caring in your method, your patients won't have pain from an IV insertion. We're talking adults here, of course. Kids are another issue and pain should be addressed for them.
Nov 15, '08Joined: Apr '07; Posts: 24; Likes: 5We can use the lido in my department, but no one does. And from personal experience I had an outpatient procedure done once and the anesthesiologist used the lidocaine which burned like fire and I still felt the IV stick on top of it all. Since that time I have always said no to lidocaine!!
Nov 16, '08Occupation: Paramedic Specialty: 23 year(s) of experience in EMS, Peds Cardiology, ER, PICU, IV Jedi ; From: US ; Joined: Jul '05; Posts: 1,083; Likes: 466Quote from RiderRNAnd for kids, why would you prolong the situation???? I've always felt that with kids you go in, and go out, as fast as possible. Get everything done in one fell swoop. So why would you torture them for the lido, then plead with them that they then won't feel anything? No! You are honest with them, YES it will be a little owie, but it will be over quickly, and you deliver. Lido prolongs the discomfort, makes the sight edematous and takes too long.
Using a J tip doesn't prolong the situation. It involves no needle, and in 15 seconds, barely the time it takes to secure a kid's arm, the lido has taken effect. Sure, they may go apesh*t prior to it depending on their age, but usually when they realize it doesn't hurt...they are much calmer. And the added benefit is that the parents don't go ballistic right along with their kid..which, as we all know, is bound to happen.
In true emergency, life or death situations, of course you wouldn't wait - if they're that bad off they won't feel it anyway. Otherwise, why not make it just that much more tolerable for a patient who's in need of your services?
And yes, better technique is always a key to relatively painless IV starts. Quick insertion, rapid vein entry, no digging...all keys to successful IV starts with minimal patient discomfort.
Nov 18, '08Occupation: RN Specialty: 2 year(s) of experience in CNA, Surgical, Pediatrics, SDS, ER ; Joined: Dec '07; Posts: 361; Likes: 218I use lido any time I can and most of the pt are thankful for it. It was tough at first for me to get used to it but now I can get it in no problem using the lido. It is much more comfortable for the pt.
Yes you are giving 2 shots but it's worth it to not feel that larger needle going in. Whenever I use the lido the pts usally say I didn't even feel that go in. Of course if it's emergent then the lido goes to the wayside but any other time I like to use the lido. If it were me I'd like you to use lido.