lidocaine for IV starts?

Specialties Emergency

Published

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?

Specializes in Emergency Dept, ICU.
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?

What state do you live in that ER Techs can start IVs, or are you an EMT-I or something?

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Screw the Lido! We work in the ED not the freeking PACU or Same Day Surg. Our patients are here because they are SICK, and have life threatening issues that need urgent interventions. Lido is a luxury, not a necessity. If you are sick enough for an IV, say you are dehydrated, vomiting, having terrible pain that an IM/PO med isn't enough, then you can have an 18g to better and more quickly hydrate you, or what if your terrible pain is related to your appendix rupturing and you need to go to the OR? That OR staff will appreciate the 18g over a 22g. And for all those patients with 10/10 pain, what's a IV start next to your 10/10 migrane that you've had for the past three weeks, and yesterday it took 8mgs of Dilaudid to help? Come on people, I'm not trying to be uncompassionate, I was recently hospitalized and in the ED, and fabulous nurse inserted a 20g in my R wrist, and YES it hurt! I remember feeling the shooting pain, looking down and asking if she put an 18g in! But, it was over fast, and she and I were on our ways,... This is ED people! And for kids, why would you prolong the situation???? I've always felt that with kids you go in, and go out, as fast as possible. Get everything done in one fell swoop. So why would you torture them for the lido, then plead with them that they then won't feel anything? No! You are honest with them, YES it will be a little owie, but it will be over quickly, and you deliver. Lido prolongs the discomfort, makes the sight edematous and takes too long.

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Specializes in Emergency, ICU.

I don't know... I wonder if technique is really the thing to perfect.

I am a complete needlephobe, so when sticking someone, I am very aware of their pain. I do it quick but gentle and usually in 1 stick.

Most of my patients comment that they didn't feel the stick at all, especially if they've had IV's inserted before and can compare.

I had never heard of using a lido prep and it's not a policy where I work so I wouldn't have a chance to try it. Also, I don't know that I'd want to stick the person twice and increase chances for skin breaks and infection.

Anyway, I do believe that if you are caring in your method, your patients won't have pain from an IV insertion. We're talking adults here, of course. Kids are another issue and pain should be addressed for them.

Peace

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We can use the lido in my department, but no one does. And from personal experience I had an outpatient procedure done once and the anesthesiologist used the lidocaine which burned like fire and I still felt the IV stick on top of it all. Since that time I have always said no to lidocaine!!

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
And for kids, why would you prolong the situation???? I've always felt that with kids you go in, and go out, as fast as possible. Get everything done in one fell swoop. So why would you torture them for the lido, then plead with them that they then won't feel anything? No! You are honest with them, YES it will be a little owie, but it will be over quickly, and you deliver. Lido prolongs the discomfort, makes the sight edematous and takes too long.

Using a J tip doesn't prolong the situation. It involves no needle, and in 15 seconds, barely the time it takes to secure a kid's arm, the lido has taken effect. Sure, they may go apesh*t prior to it depending on their age, but usually when they realize it doesn't hurt...they are much calmer. And the added benefit is that the parents don't go ballistic right along with their kid..which, as we all know, is bound to happen.

In true emergency, life or death situations, of course you wouldn't wait - if they're that bad off they won't feel it anyway. Otherwise, why not make it just that much more tolerable for a patient who's in need of your services?

And yes, better technique is always a key to relatively painless IV starts. Quick insertion, rapid vein entry, no digging...all keys to successful IV starts with minimal patient discomfort.

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Specializes in CNA, Surgical, Pediatrics, SDS, ER.

I use lido any time I can and most of the pt are thankful for it. It was tough at first for me to get used to it but now I can get it in no problem using the lido. It is much more comfortable for the pt.

Yes you are giving 2 shots but it's worth it to not feel that larger needle going in. Whenever I use the lido the pts usally say I didn't even feel that go in. Of course if it's emergent then the lido goes to the wayside but any other time I like to use the lido. If it were me I'd like you to use lido.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

I do work Same Day Surgery, so it isn't a good comparison to the ER. But, I will say that it takes maybe 5 seconds longer to put in the lidocaine and the patients appreciate it so much. Most of them do not even feel the stick. We use 18 gauges almost exclusively so these are big IVs that we have to get in and they do hurt. I don't like it when nurses ask patients, "Do you want 1 stick or 2 sticks." A 27 gauge TB syringe is way, way different than a 16 or 18 gauge angiocath. Yes, the vein does get obliterated with the bleb but its still easy to hit.

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Specializes in Telemetry & Obs.

I'm a VERY hard stick and if you're coming at me with an 18g IV you'd better have some lido in your other hand!!

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Screw the Lido! We work in the ED not the freeking PACU or Same Day Surg. Our patients are here because they are SICK, and have life threatening issues that need urgent interventions. Lido is a luxury, not a necessity. If you are sick enough for an IV, say you are dehydrated, vomiting, having terrible pain that an IM/PO med isn't enough, then you can have an 18g to better and more quickly hydrate you, or what if your terrible pain is related to your appendix rupturing and you need to go to the OR? That OR staff will appreciate the 18g over a 22g. And for all those patients with 10/10 pain, what's a IV start next to your 10/10 migrane that you've had for the past three weeks, and yesterday it took 8mgs of Dilaudid to help? Come on people, I'm not trying to be uncompassionate, I was recently hospitalized and in the ED, and fabulous nurse inserted a 20g in my R wrist, and YES it hurt! I remember feeling the shooting pain, looking down and asking if she put an 18g in! But, it was over fast, and she and I were on our ways,... This is ED people! And for kids, why would you prolong the situation???? I've always felt that with kids you go in, and go out, as fast as possible. Get everything done in one fell swoop. So why would you torture them for the lido, then plead with them that they then won't feel anything? No! You are honest with them, YES it will be a little owie, but it will be over quickly, and you deliver. Lido prolongs the discomfort, makes the sight edematous and takes too long.

I so agree!!!! Someone comes in having an acute MI...shoot....we need two large bore IVs when they go to the heart cath lab....working for a 20minute door to balloon....no lido....it's the ER

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Specializes in CNA, Surgical, Pediatrics, SDS, ER.

Where I work most pts are clinical -not emergent. Yes if they are critical of course there is no time for lido-- but if time warrants it why not?

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Where I work most pts are clinical -not emergent. Yes if they are critical of course there is no time for lido-- but if time warrants it why not?

It's not in our policy. Plus....we're not allowed to have meds on us or in our pocket. We have the pyxis system and they would have to purchase huge amounts of lido and not to mention the storage issue. We have a 65 bed ED Level II Adult and Pediatric Trauma Center. Huge amounts of lido would be needed.

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Specializes in ICU, ER.

Having just spent 30 days in the hospital and probably having 25 iv starts, it's one thing to have 22 or 20 in the forearm. A 20 in the back of the hand is a differrent story, and a few minutes drawing up and giving the lido was much appreciated. The savings in time due to the ease with which the line went in made up for the time spent on the lido.

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