How does your facility handle Lidocaine?

BrnEyedGirl, BSN, MSN, RN, APRN · Jul 13, 2009

We are allowed to mix the lido with the bicarb, but only when ready to be used. We are also wasting a huge amount of meds,...there really is no such thing as a multi dose vial in the ER. Every time we run out of 4ml (1mg/ml) Morphine pre filled syringes we may draw up 2mg from the 10mg bottle, waste the other 8mg, then an hour later pull up 4mg from a new 10mg bottle, waste the other 6mg, then two hours later pull up 4mg and wast the 6mg again,...this is such a waste. It would be nice if we could somehow lock that bottle up for only that pt, and then wast it on dc.

rjflyn, ASN, RN · Jul 13, 2009

Have never buffered lido. Have only seen it done on a rare occasion. Also if the doctors and PA's dont know how to do it then maybe they not ought to be doing it. Also maybe you need to get your pharmacy involved.

firstaiddave908 · Jul 13, 2009

it sounds like the hosptial might need to do a training course on how to draw up meds for the doctors so they know the right way if it is aganist hosptial protocall for a RN to do it. getting pharmacy invloed is a good idea too.

JordanRose · Jul 13, 2009

I personally would NEVER give anything that I haven't drawn up myself. I would never give anything to a pt that I haven't checked over myself. Med errors get made that way.

DolceVita, ADN, BSN, RN · Jul 13, 2009

I personally would NEVER give anything that I haven't drawn up myself. I would never give anything to a pt that I haven't checked over myself. Med errors get made that way.

Really good point.

GadgetRN71, ASN, RN · Jul 13, 2009

My issue isn't with the nurses mixing and drawing up the meds(we do this in the OR) but with the putting the syringes aside for later use by someone else..how do you know they mixed it correctly, or that it's even the right meds to begin with?

Some docs do like to buffer the Lidocaine..I used to work with a group of general surgeons who did this.

JordanRose · Jul 13, 2009

Let me clarify this a bit. If I actually see the person draw up the medication from the vial that I can see what the med is (as for example in an emergency situation), and that person hands me the syringe, then I will give it. If I can't see what has been drawn up, I don't give it. Period. I had an RN friend once who didn't abide by this rule, and she ended up giving Vistaril IV. Fortunately, the pt didn't suffer any long term effects from it but my friend learned a valuable lesson that day. NEVER, EVER, give something that you haven't drawn up yourself.

firstaiddave908 · Jul 13, 2009

I personally would NEVER give anything that I haven't drawn up myself. I would never give anything to a pt that I haven't checked over myself. Med errors get made that way.

Thats a very good point . Thank you for puting that I never thought of that im a new rn student and I will be starting in the Fall of this year.

miwachiru123 · Jul 16, 2009

I personally would NEVER give anything that I haven't drawn up myself. I would never give anything to a pt that I haven't checked over myself. Med errors get made that way.

This is actually the reason that our current practice was stopped.

The lido is buffered with bicarb, then labeled with whats in it, the date, time, and initals. Then the syringes were stored away in the drawer. Its the PAs who use the lido at my facility, not the nurses, so ultimately is this OK in the big picture? I am not using the medication, and the PA trusts me or any nurse enough... But is it against the nurses scope to draw, mix, and label meds in syringes for later use? I think its something that only a pharmacist can do..

JordanRose · Jul 16, 2009

This is actually the reason that our current practice was stopped.
The lido is buffered with bicarb, then labeled with whats in it, the date, time, and initals. Then the syringes were stored away in the drawer. Its the PAs who use the lido at my facility, not the nurses, so ultimately is this OK in the big picture? I am not using the medication, and the PA trusts me or any nurse enough... But is it against the nurses scope to draw, mix, and label meds in syringes for later use? I think its something that only a pharmacist can do..

Well, if I were a PA I sure wouldn't be using it labeled or not. You can't verify 100% what is in that syringe, even if it is labeled. We have a couple of nurses who will tell me they left a labeled syringe in the med drawer with such and such med in it because they thought it was wasteful. The first thing I do is pitch them.

Are they not teaching this yet in nursing school? Not only should this rule apply to IV/IM medications in syringes, it should also pertain to po meds that have been removed from their unit doses package and placed in a med cup. I was taught to never give ANY medication that I haven't prepared myself.

As for being out of the scope of nursing practice I suppose that would depend on your particular's state's nurse practice act. It would seem to me that if nurses were doing that it could be considered somehow of mixing and dispensing without a license.

It basically boils down to it is not a safe practice, period.