I have a quick question. I'm a new grad with very little ER experience. I have been working with a Doc who has done several things that I'm concerned about, but I'm not sure if I should be.
First question, Don't physicians normally use lidocaine before applying sutures and or staples?
Second, Advice please. This is a tiny hospital, if I had issues with this guy, what is the BEST way to go about getting things changed without everyone knowing I was the one reporting it. Has anyone else been through a similar situation?
Re:Lido with an IV start? Seemed like a lot of people were for using lido (I was not one of them), so it is refreshing to hear others that don't like to use lido for IV starts. That said, our docs sometimes don't use lido either. Usually it is when they are using staples to close a scalp wound. I guess staples are no worse than plucking eyebrows?! :chuckle We use topical xylo for small lacs on kids. It beats wearing yourself out holding them while the doc sticks them to numb them and THEN sticks them for the sutures! As for anything else the doc does that makes you go "hmmmm," ask him/her. Like someone else said, some docs love to teach and most are nice about answering questions; remember, the only dumb question is one NOT asked.
JMHO,
Pam :)
P.S. I'm one of those that if you have to put an IV in, JUST DO IT! No sticks prior to sticking me!
Just ask the preop people to do without the lido...you are the patient afterall, and have more rights at that moment than any other time. And I don't know what kind of IV's your having, but as an anesthesia student, we start 18's almost all the time for surgery. Would you really rather an 18 over a stick for some lido? I'm just curious, seriously not be a smartbutt.
Honey, I used to have students practice IVs on me in school. The lido stings like hell...an 18 guage IV start doesn't.
I have tried to refuse it several times, and been told it was "policy" and a big deal made of writing the refusal in the chart. It is never used on the Floor so I do not know what the deal is.
It is right up there with phlebotomy taping up the stick site so hard that it rips skin off to remove the bandage. Taking off the bandage hurts more than the stick. Yet, if you refuse it, they get really hostile, because its policy.
As for topical anesthetics, we use a mix of lido, epi, and tetracaine topically for pedi lacs and for on road rash, etc. BUT, you have to leave it on for at LEAST 20 minutes for it to work well. So there is a time consideration about it.
As to size v. pain, lemme tell ya'......I still let students practice on me when they're in the E.D. and it's kind of slow (we go over the whole procedure first and do a LOT of talking before the stick), and I used to have them use a 22 ga. (smaller size, less pain right?). Well, the 22 hurts MORE than the 20. Also, when you donate blood, THEY use a 16 ga, and don't use lido first, and it hurts no more than the 20 the students use on me.
I'm also one of those no lido people. And I personally don't care if it is policy or not and how big a deal they want to make. If they make it TOO big of a deal, I'll be happy to leave AMA and talk with admin and the state ACHA about their attitude toward patient rights. See how big a deal it becomes THEN.
I once cut three fingers on one hand (removing blade from non-disposable scalpel 20some years ago). I will attest the lidocaine injection hurt way worse than the suture needle. I know this because the lido wore off on the last finger and I opted for no more injections so I had 2 sutures on a non-numbed finger - it was way less pain than the injection. Granted nerve blocks are very painful, and your case probably was not a nerve block, but ask the Doc because there was probably a good reason to skip the lido.
I work in a surgery center and we offer Lidocaine to all of our patients, if they don't want it they don't get it. We admit between 20 - 30 patients a day and I have heard countless responses from patients say " How come they never use lidocaine in the hospitals?" I have had IV's both ways and can say the lidocaine poke is nothing compared to the IV stick. I have seen patients suffer because they have had to be poked several times without lidocaine. I trained with a nurse anesthetist and have come upon a very rare patient since then that ever really minded the lidocaine. I have never forced a patient a to use lidocaine if they did not want it. This is JMHO.
When the squad told me that they were going to start an IV prior to leaving for the hospital, I warned them that I might pass out. I had lost 4 units of blood, but did not appreciate the severity of my condition. My concern was to alert the squad so that they would not be overly worried should this occur. Neither this IV, nor the second one started in the ED, seemed any more painful than the subsequent blood draws. Lidocaine was never offered or used. In fact, the blood draws that evening were far more painful than the IVs or previous blood draws. For some reason, it took several attempts to get blood. They made a perfect entry into the vein each time, but were unable to withdraw blood. It was within my ability to endure pain without showing a response, but made me wonder if people who were hard sticks had to endure this much pain each time. As I got better, subsequent blood draws were progressively less painful.
I definitely would not want Lidocaine prior to an IV or blood stick, because the longer the procedure is drawn out, the greater the risk that I pass out. I suppose that I should donate blood to make up for the 2 units they had to give me, but the risk of passing out, possibly to the point of losing control of my bowels, is too high on such a lengthy procedure.
When the squad told me that they were going to start an IV prior to leaving for the hospital, I warned them that I might pass out. I had lost 4 units of blood, but did not appreciate the severity of my condition. My concern was to alert the squad so that they would not be overly worried should this occur. Neither this IV, nor the second one started in the ED, seemed any more painful than the subsequent blood draws. Lidocaine was never offered or used. In fact, the blood draws that evening were far more painful than the IVs or previous blood draws. For some reason, it took several attempts to get blood. They made a perfect entry into the vein each time, but were unable to withdraw blood. It was within my ability to endure pain without showing a response, but made me wonder if people who were hard sticks had to endure this much pain each time. As I got better, subsequent blood draws were progressively less painful.
I definitely would not want Lidocaine prior to an IV or blood stick, because the longer the procedure is drawn out, the greater the risk that I pass out. I suppose that I should donate blood to make up for the 2 units they had to give me, but the risk of passing out, possibly to the point of losing control of my bowels, is too high on such a lengthy procedure.
I've had more people tell me they didn't even feel the IV when I start it. And this after they tell me they're a hard stick and their veins roll.......... :rotfl: EVERYBODY'S veins roll. They're made to do that.
A doctor once explained to me that lido can cause problems on its on by increasing swelling at the site and obscuring the lac and causing worse scarring...for breast biopsy they don't use it because the lump will flatten out and disappear.
I know our docs weigh the pain versus the'look'..if it's a big lac with a ton of sutures we use lido because it becomes way too uncomfortable..for less than 5 the doc goes ahead but keeps asking the patient how they are doing and we will certainly stop and inject lido if the patient can't tolerate the suture placement.
we presedate the little ones and use lido because the pain is just too much......I have had docs interestingly enough inject lido when they were finished suturing as it relieves pain at the site and will last long enough for them to fill a prescription and get home. A lot of surgeons also do this at the incision site after surgery to stay ahead of post op pain.
When I worked er all our docs were very learner friendly and I got to suture more than my share of head lacs.....anything that wasn't on the face or hands and was pretty small we got to suture with guidance....we didn't get to inject the lido..that takes practice and a really good knowledge of nerves and blood supply.
I had sutures done both with and without lido...I'll take the extra sticks to be numbed, thank you.
Lido for IV starts is the standard in my area with the exception of one hospital which uses NS (gate control theory -vs- pharmocologics). I prefer to get the lido, I am not an easy stick and I prefer NOT to feel them dig for a vein.
Yes, lido stings but the blessed numbness is almost instant.
Lido for an IV stick or phlebotomy?? Ya gotta be kidding! We use an EMLA patch for kids if they're fussy about needles, but I've NEVER EVER had it used on me, except for suturing a laceration.
MrsWampthang, BSN, RN
511 Posts
Re:Lido with an IV start? Seemed like a lot of people were for using lido (I was not one of them), so it is refreshing to hear others that don't like to use lido for IV starts. That said, our docs sometimes don't use lido either. Usually it is when they are using staples to close a scalp wound. I guess staples are no worse than plucking eyebrows?! :chuckle We use topical xylo for small lacs on kids. It beats wearing yourself out holding them while the doc sticks them to numb them and THEN sticks them for the sutures!
As for anything else the doc does that makes you go "hmmmm," ask him/her. Like someone else said, some docs love to teach and most are nice about answering questions; remember, the only dumb question is one NOT asked.
JMHO,
Pam :)
P.S. I'm one of those that if you have to put an IV in, JUST DO IT! No sticks prior to sticking me!