lidocaine for IV starts?

[NativeTexan]

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?

[Uptoherern, RN]

as an aside, I always have to remind my dentist to NOT use lido with epi. The epi maes my heart race...........

[RainbowSkye]

Let me tell you, I've worked in ERs which encouraged using Lidocaine for IVs and others who felt it wasn't necessary. After using Lidocaine on most everyone in the ER that routinely used it, it's hard for me not to now. I've had them both ways myself, and let me tell you Triage Troll, I choose Lidocaine (even if it is two sticks, as you say).

And, by the way, you evaluate who it is appropriate to use it on before you hit them with the needle. Nope, I don't use it when someone is crashing, I don't use it on the very elderly (the Lido just kind of sprends out under the skin and makes a nasty looking bruise), babies, patients with allergies to it... I use my nursing judgement here.

I've not had a problem with it hiding the vein. It actually helps because I have a landmark to find the vein if I need it. And I find that patients are more relaxed which makes the whole procedure easier. I can't tell you the times patients have asked me why nobody used Lidocaine on them before or if I'd start their IV for them if they ever need another one.

Just my two cents.

[NativeTexan]

Thanks ya'll,very helpful!

[teeituptom, BSN, RN]

Well said RainboweSkye

Well for your GI bleeders you need Large Bore IVs

you get a 14 or 16 poked into you without Lido, thats just being nice, only takes a few seconds.

Kidney stone patients are hurting so much as is, but again you still use a large bore in case of other probs. Again using lido is nice

All it takes is o.1 mls given ID right over the vein.

makes life so much easier

easy is better any day

[Shed13911]

Boy, I have had IVs started both ways and I can tell you that it does make a huge difference. The Lidocaine burns for just a second but then you can't feel the needle after that. When you have to keep moving the needle around to find the vein, it is a God-send. I wish all nurses would do it as often as poss. Nobody wants to be in any more pain than they have to be!! :imbar

[nekhismom]

I'm a hard stick and I usually get TORTURED when I need an IV. Actually, when I had my last surgery, I was given versed as part of my pre-op meds. I was sleeping soundly. Yet i DISTINCTLY remember waking up and screaming "OUCH! You're KILLING me, here!! STOP IT!!" And trying to punch my nurse. Why? HE was starting an IV and DIGGING around on me. I cried and begged and pleaded with the nurse. I even told him he would not be successful with an IV bore larger than a 22. He just kept on digging. He infiltrated sites as lrg as a golf ball on my inner forearm. He used the same needle in 2 different sites. I watched him and cried and begged. I sure wish someone had offered me lidocaine. Finally, the anesthesiologist offered me my anesthesia and I tearfully accepted. My surgeon told me that my surgery started over 2 hours late because they couldn't get an IV placed, and when they finally did get it, anesthesia did it. Boy, I sure could have used some lido that day. That was more painful than the post-op pain. ANd imagine, if I could feel and remember this after a nice big dose of versed, how it must feel for me without versed???

[kyti]

In our OR holding area we use ID NS and it works just as well as ID lido. I have had IV's with and without and definatly prefer to have my site numbed. Our hospital policy is to offer it to everyone but in reality the OR is the only place that really does it.

[teeituptom, BSN, RN]

Its policy in our ER

I support it all the way

[MrsWampthang, BSN, RN]

when I was going through skills lab as part of my orientation, lido was never introduced for IV starts. Nor was I taught about lido with IVs as part of my orientation in the ER. As I said before, I don't use it and do quite well without it. I don't like needles either but I would rather have someone get the dang IV in and get it over with than stick me twice. :chuckle

Pam

[Rapheal]

I have used it twice. The second patient refused an IV without Lido. The doc was resistant to ordering the Lido because he said it would cause vasoconstriction and make the placement on an IV more difficult. But we did it and it worked. I say if the patient wants it- use it.

[athomas91]

CHECK your policies...although practiced.....in many hospitals and states lido is still an anesthetic and against the protocols for nurses to inject. some have remanded those policies...however you should check FIRST.

[traumaRUs, MSN, APRN]

Ouch - Pamela - come on girl - times change! I agree that EMLA takes time to work and certainly infiltrating with Lido takes a little time too, but if it leads to better patient care, so what? No - I don't use anything in a crashing patient or a trauma, etc. However, I'm older than you and things can and do change.