lidocaine for IV starts?

MryRose · Mar 5, 2004

Since I am still doing my pre-nursing schedule, I can only respond as a patient who has been on the receiving end.

Having had c-sections, hysterectomy and kidney stones..... I've had IV sticks without Lido in regular hospital or ER setting..... It HURTS! Especially when I was dehydrated.... ouch

I recently had a procedure done in a surgery center and was really dreading the IV. Much to my great surprise and releif, it was absolutely painless! The Rn told me they only use a lidocainmix and they are all virtually painless.

This is something that I will carry with me into my furture nursing practice because it makes a HUGE difference for the patient.

Hugs!

MaryRose :balloons:

subee, MSN, CRNA · Mar 6, 2004

Excuse me - because I was never taught to use lidocaine to start an IV, I never use it? What could come of professional growth if we all displayed this kind of attitude.? I'm a CRNA and very rarely start an IV without lidocaine. I've had nurses practice IV starts on me and they can really hurt on a patient that's already miserable. It only takes a second. Draw up a few in insulin syringes when you're at the lidocaine trough and you'll have them when you need them. We here to treat them, not to torture them. Subee

TazziRN, RN · Mar 6, 2004

Subee, I agree. I don't always use it but I will if the patient asks or if I think the patient would do better with it, or if I'm starting a large-bore line. I have never met anyone in anesthesia who DIDN'T start one with lido. I've heard many nurses say that if they inject lido first, they miss the stick. I always go in the same puncture and rarely miss.

OHHNURSE · Mar 6, 2004

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?

I worked at Deaconess in OKC for 5 years and their IV team came up with a JAMA article recommending subcute normal saline injection (bleb) for IV insertion. It was proven to be as effective (I can testify to that from my own personal experience with 'naked' IV starts vs using the NS. There will be a small amt of bleeding after the stick (usu in a tuberculin syringe with a 27 ga needle) and you use that little red dot and go back into the same 'hole'. The problem with lido/xylo is that sometimes you could get a bottle with epi accidentally and that will cause HUGE problems with SQ injection.

MrsWampthang, BSN, RN · Mar 7, 2004

Pam - I apologize. I too noted the age difference. All I'm saying is that nursing changes, new drugs, new ways of care delivery and we too must change with the times. Also - I too do prehospital care as a pre-hospital RN - it is difficult to start an IV in an ambulance. I live in a rural area and our transport times are up to one hour in the winter. Sorry - if I offended.

Sorry about my reaction. Guess I got up on the wrong side of the bed that day.

Pam

teeituptom, BSN, RN · Mar 7, 2004

Unleess Im going golfing anytime I get up otherwise is getting up on the wrong side of the bed

Ms.Hobbes · Mar 7, 2004

I work in an outpatient surgery center, plus occasional shifts at our local hospital and that is our standard to use lidocaine before the IV stick. When I first started nursing I was told by many nurses that the use of Lidocaine would make starting your IV more difficult. I have been a nurse for ten years now and have used Lidocaine faithfully now for the last few years and have never really had a problem, just a patient very thankful not to feel the pain of the IV start. I feel if you have the time to start an IV, obviously in an emergency situation you wouldn't, use the lidocaine. I have had IV's started both ways and with Lidocaine is so much nicer. The initial stick with Lidocaine is with such a small needle, the burn from the Lidocaine hurts more.

Shotzie · Mar 12, 2004

You've reassurred me Triage Troll. I'd been admiring your responses and was disappointed to see the vehemance of your reaction. But everyone is allowed the priviledge of having a bad moment or a bad day.

The issue here seems to me that some of us "old timers" may not be used to using the lido for patient comfort. My concern is that as nurses we should not get caught up in the of trap that "it's not the way we do things here".

I've worked (for a short time then back to a big hospital) in an ER where the status quo was how it was and new thoughts and ideas were met with strong disapproval and negativity. We should always be looking to do our tasks better, more efficiently and be a better advocate to our patients. New ideas should be met with interest, be investigated and implemented if appropriate to your patient population and your center. Sometimes it's hard not to get tired, jaded and burned out but keeping the job interesting will go a long way toward defeating negativity.

teeituptom, BSN, RN · Mar 13, 2004

Old dogs not only learn new tricks we invent them

erjulie · Mar 18, 2004

I've used lido multiple times in Endoscopy, where almost all is elective. No difference in starts, except where the vein is really tiny, then you can have some obliteration. We are going to start using ethyl chloride. remember that? If you do, you've dated yourself. really effective, and fun with kids because there is no stick, just spray, and they LOVE the thought of frozen skin... :chuckle

teeituptom, BSN, RN · Mar 18, 2004

If you kenw Ethyl

like I knew ethyl

anyway one of the EDs was using ethyl on a guys thumb for a subungal hematoma

He then used a cautery stick to make the hole in the nail

needless to say there was a big flash

didnt hurt the pt or the doctor either

Except the doctor had a prob with stress induced incontinence

mazz · Mar 18, 2004

Lido can work well, but it really does make veins disappear. Maybe I was just unlucky to get whatever small percentage of the population that lido does that to, but since that happened, I do not use it anymore.