lidocaine for IV starts?

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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 was trained by one of the best nurses I ever met in starting IVs and she also used ID NS, stating it was just as effective as lido. All patients that I have used it on agreed that it helped and did not cause the burn that lido does. Each circumstance is different. With some kids and adults, one stick is all you're going to get and I have to make it the one that counts.

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I was trained by one of the best nurses I ever met in starting IVs and she also used ID NS, stating it was just as effective as lido. All patients that I have used it on agreed that it helped and did not cause the burn that lido does. Each circumstance is different. With some kids and adults, one stick is all you're going to get and I have to make it the one that counts.

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Specializes in ER,ICU,L+D,OR.
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

Now that is a strange story

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Specializes in Post Anesthesia.

Our hospital started this as a "nursing order" recently. I'm a little unsure of how they justify the nursing order of a prescription medication (lidocaine)and an invasive proceedure(SQ anesthetic wheal) without additional orders by the physician. I have only seen the order used in the pre-surg area where they frequently start "large bore" IVs and in Oncology when a patient dosen't have a central or PICC line and requires frequent IV restarts.

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Specializes in ER,ICU,L+D,OR.

we do it all the time

Found in our Policy and Procedures.

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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

We don't use the lido for IV starts, nor would we be allowed to draw up lido in syringes and carry them around with us. Sorry, but I disagree, if the patient needs an IV, I do not consider that torture....

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I've found that using lidocaine increases my rate of missed IV's. Without it, I can get in virtually the first time every time (except for those "everyone has a bad day" type of days). If I use lidocaine, it's almost a guarantee I'll have to stick you again because I feel it displaces the vein or causes some type of irritation to increase irritability in the vein which them causes it to spasm.

Maybe it's all in my head, but I much prefer to start without - quicker, one stick, and therapy initiated faster. This is not torture but providing fast, competent, professional care to my patient.

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Specializes in Emergency Dept, ICU.

TraumaNurseRN,

As usual I couldn't agree with you more. It is an ER, if it is such an emergency than SUCK IT UP and take the 2 second IV stick. And if you ask me to "numb it up", I'm just going to go from a 20g to an 18.

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Specializes in ICU and EMS.

I'm interested in hearing more about using normal saline. I'm an ER tech, so I know that I would never be allowed to use lido. I've not heard of using either NS or lido for IV starts-- both from the hospital and in nursing school. Do you still use 0.1ml? Do you go directly over the vein, or more to one side? Sometimes the vein that I'm targeting is very superficial, and I wouldn't want to accidently hit the vein and blow it with the initial needle. Also, those of you who do use NS-- do the techs use it as well?

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Old post alert! This started in 2004 so you might not get responses from some of the posters. The information, however is still timely. Also wanted to point out that drawing up meds ahead of time and either carrying them around in your pocket or having them at your workstation is a HUGE and expensive JCAOH violation! This includes saline, even the pre-packaged kind. There are, of course, some area that are exempt from this but the ER isn't one of them.

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Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

in 22 years of nursing i have never used lido for iv start .never found the need .get my ivs in 1 shot .and i personally have had ivs placed 18 20 and 22 .during 4 hospitalizations .its not a big deal.i have worked 5 ers and have never had a policy of using lido for stick certainly couldn't carry the lido in pocket .jacho violation and unsafe .the only time i have used emla or lido is when i worked dialysis used 14-17 gauge needles.

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

I've started literally thousands of IVs. Lidocaine is great, and if it's available to you..give it a try. My hospital utilizes a new form of the lido..in a J Tip. It is a syringe with .3cc of lidocaine and it is injected through the skin via compressed air - there is no needle...the force of the carbon dioxide pushes the lidocaine into the skin. It forms a small bleb and bleeds just slightly but after 15 seconds you can put an 18 or 16 in them and they won't feel it. I'd pull up a link but my computer is going haywire at 0440.

Have a great day.

vamedic4

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