Intradermal lidocaine for IV starts

[hardworkingrn]

I am looking for anyone who may have a policy in regards to using lidocaine for starting IV's. We are trying to institute this where I work and could use something to go off of. Thanks.

[Mystery5]

We are allowed to use it, but I never do since it seems to make the vein disappear.

[meownsmile, BSN, RN]

We dont use lido for iv starts, seems a little silly,, two sticks insead of one. The only thing it helps is the patients psycie.. I always ask the patient, when they question about using lido if they want one stick or two. They usually opt for one.

[palesarah]

It's becoming our policy to use or at least offer 1% lidocaine for IV starts. On OB we start everyone with an 18ga unles they have really tiny veins. Our patients have reported much less discomfort with the lido. Many of our nurses were hesitant to start using it for fear the lido bleb would obscure the vein, but one of the anesthesiologists did an inservice showing proper technique and starting one with lido and one without on the volunteer nurse (an old school, one stick, no lido kind of gal). Changed her mind and a lot of others! Most of us inject the lido directly where we want to start the IV and then if the lido obscures the vein underneath, we use the injection site from the lido as our guide. I actually use the needlemark from the lido as my guide and have as good results as I did starting IVs without. I'm not a great IV starter to begin with though.

We've had poor marks for our IV starts in the Press Gaineys so that's why there's the new push to start using the lido. The rest of the hospital uses bacteriostatic saline instead of lido. We used to have that but it was too easy to confuse it with NS for mixing baby meds and thus too dangerous to keep on the floor.