Intradermal lidocaine for IV starts

Jamesdotter · Jan 9, 2005

We were starting to change from lidocaine to intradermal normal saline for IV starts about the time I retired. It was supposed to work about as well as the lidocaine, with no allergy concerns.

donmomofnine · Jan 9, 2005

When I worked L&D, we always used lidocaine for IV starts. Now that I have had both procedures, with and without, done on me, the lidocaine burns :angryfire and is much more painful than a start without it! Why is your facility wanting to use lidocaine?

begalli · Jan 9, 2005

The docs are the only ones who use lido for IV starts and that's for starting central or art lines. Oh, the picc RN does as well.

In a previous job, I used EMLA cream for venipuncture.

Sorry, I'm absolutely not one iota of help to you, but I wanted to post!

luvrn · Jan 9, 2005

I also have had IV starts with and without Lidocaine. If the person who is sticking is good.....NO lidocaine, I had more pain with the lidocaine from the burning vs. just sticking me for the heplock.

RE Agent · Jan 9, 2005

The docs are the only ones who use lido for IV starts and that's for starting central or art lines. Oh, the picc RN does as well.
In a previous job, I used EMLA cream for venipuncture.
Sorry, I'm absolutely not one iota of help to you, but I wanted to post!

EMLA cream is the best, but the waiting time can be a problem. Sometimes IV have to be started quickly. This is good for the peds patient.

I've never seen a policy for lido use, we just used it, if the patient wanted it.

It does hurt, like a bee.

pigtails · Jan 10, 2005

Maybe a 22G hurts less wihtout lido. What about and 18G? Most patients thank when I use the lido.

I worl in an open heart surgery unit where, more often than not, patients are difficult ti stick:therefore, you somtimes have to "fish" for a vein, which can be painful.

I have also had it done both ways, 22G. no need, anything bigger, go lido!

Burnt Out, ASN, RN · Jan 10, 2005

I know our ambulatory surgery dept. uses lidocaine for IV starts-I've seen the policy, but I am on leave at the moment.

If I have to have an 18 or 20 guage for surgery or something, I will put up with the burning of the lidocaine than someone digging and fishing without it-I'm a very hard stick!

RNPolly · Jan 10, 2005

I work in surgical pre-op where all IV catheters must be 18 gauge (and, occasionally, larger). We start many, many IVs daily, and I am a true believer in the effectiveness of the lido; pain and anxiety are greatly reduced for our patients. I believe we are the only unit in our hospital to use lidocaine for IV starts, but our patients are most appreciative (pharmacy buffers it for us to decrease burning). After an unexpected ER visit of my own recently, I was again convinced of the effectiveness of the lido start - dang, that 18-gauge hurt without lido!

Anyway, to answer your original inquiry, sorry I'm no help; we have no policy on its use.

donmomofnine · Jan 10, 2005

Maybe a 22G hurts less wihtout lido. What about and 18G? Most patients thank when I use the lido.
I worl in an open heart surgery unit where, more often than not, patients are difficult ti stick:therefore, you somtimes have to "fish" for a vein, which can be painful.
I have also had it done both ways, 22G. no need, anything bigger, go lido!

sounds like a plan to me!:)

stevierae · Jan 10, 2005

I don't know of any particular policies--wherever I have worked, it was up to the individual RN's discretion--heck, maybe that WAS the policy!

In the OR we always start large bore IVs, so I have always used 1% Lidocaine (Plain) but I buffer it with NaHCO3 to make it sting less--OR I use 0.5 % Lidocaine (Plain) and then I don't have to buffer it.

If you have a multidose 30 cc vial of 1% Xylocaine that everyone accesses to start IVs, you can add 1 cc. of NaHCo3 to every 10 cc. of Lidocaine--that is, 3 cc. to 30 cc--or, if it's a 50 cc. vial, you add 5 cc.

Check with your pharmacist to get the correct concentration of NaHCo3 if you are going to do this--it is NOT the NaHCO3 that comes in a Bristoject for metabolic acidosis in code situations--IT COMES IN A VIAL, like Lidocaine, and is a different concentration!!!

I think that the easiest solution for you, rather than bothering with buffering, is to get a policy allowing you to use 0.5% Xylocaine Plain. It can't hurt to ask if you can use your own discretion to do this without a written policy.

Marz · Jan 10, 2005

At my hospital our Ambulatory Care Dept always uses lido..I work in the E.R. and ICU and they want us to start to use it in those areas as well...

The only drawback I've seen is that after you inject the lido the vein seems to disappear and then you're "fishing" for the vein anyway...personally I'd rather just have 1 stick and get it over with...patients have also voiced the same...