Lidocaine prior to IV start?

eitak · Apr 10, 2006

Two years ago, having never had an IV before and being terrified of almost everything during labor of my first child I appreciated being numbed before the IV was administered. I remember thinking, "that size needle must REALLY hurt" but I hardly felt a thing. It was appreciated!

jonear2, RN · Apr 10, 2006

Uuuuummmmm....NO! And ya know what, it shouldnt be. I am very sensitive to pain issues, but come on! One little stick, we've all had them. I dont know how quick the lidocaine works but even the stuff we used on the kids during peds rotation (?name?) took like 30 minutes to work. Plus the instructor should know that common practice is not to numb the area and should have instructed you to do so before you started. I wouldnt worry about it. You work in the ER right? I dont think you all have the time to deal with numbing adults beforehand? Maybe I am insensitive, but really?

SigmaSRNA · Apr 10, 2006

I am in a front-loaded program and will be starting full-time clinicals in August (thank goodness), but this semester we have had several "observation days." During my last obs day I was with one of my professors who asked me to go ahead and start a peripheral IV on our patient. Well, imagine my surprise when I got reamed a new one for not numbing the patient with lidocaine beforehand. Now, I have been an ER nurse for two years and have started a million IV's and I have never numbed a patient (with the exception of children) before starting an IV. My professor said to me, "We are in the profession of preventing pain, why would you not numb the patient first?" Is numbing the IV site beforehand common practice everywhere or is my professor just being overly anal-retentive? Any comments would be appreciated! Thanks!!!

That is crazy! So instead of one stick they get two. Crazy!

jonear2, RN · Apr 10, 2006

Wait, was the lido topical or subq? Either way still stupid, but just curious.

kat911 · Apr 11, 2006

NO it's not a usual practice. In our facility only the Day Surgery people numb sites with lidocaine. Most peds IV's EMLA is used. IMHO lido hursts more than the stick. The one time I was numbed first they nurse didn't even go to the numbed site. :nono: Why torture the patient twice. Your instructor was wrong, besides she's the one responsible for making sure you know the standards where you are doing clinicals. :idea:

palesarah · Apr 11, 2006

hmm. Having had IVs with and without lidocaine, I much prefer to have an IV started with local. I'd prefer the bee sting of lido to the big stick. (Although my new hospital uses buffered lidocaine, so patients are even spared the sting of the lido)

A couple years ago, the hospital policy where I was working at the time changed to be that local anesthetic had to be offered before every IV start. There was a lot of resistance from nursing, especially nurses who had been in the field for many years. One nurse in particular I can think of, who was one of my mentors, had been a nurse for 20+ years and was an excellent IV start. One of the MDAs did an inservice for our department on IV tips & tricks, and she offered herself up as the guinea pig. The MDA started 2 IVs on her, one with and one without lidocaine. She became one for the biggest supporters of, and a resource person for, IV starts using lidocaien after that. Intradermal lidocaine doesn't take any significant amount of time to be effective. It's quick and effective and most importantly, it makes your patient feel like you really care about decreasing their discomfort- I have seen these comments OVER and OVER in patient satisfaction surveys! It's a small thing that makes a big difference.

jwk · Apr 11, 2006

Actually it's a pretty common practice in most of the facilities I've been in. All of our pre-op nurses use subQ lidocaine. Do you really want to root around with a 14 or 16 ga needle on someone? With easy sticks with small catheters, it probably isn't that big a deal. But our GI area doesn't use local and their patients hate it. Even if the lidocaine burns a little, they don't feel the other needle, which the patients really like. Trust me, your patient will appreciate the lidocaine (so would you if the roles were reversed) and luv ya for it.

Those of you who disagree can come on over and I'll start your central line without local - hey, it's just one stick - usually - I hardly ever miss.

eitak · Apr 11, 2006

It was subq!

Jolie, BSN · Apr 11, 2006

Fron the patient's perspective, I think it is a good idea to offer a local, and then respect the patient's wishes.

I've had a number of IV's over the years, for childbirth, surgeries, and ER visits. My veins are like garden hoses, and no-one ever has trouble getting an IV in.

About 10 years ago, I had cancer surgery at the hospital where I worked. Needless to say, it was a stressful time, and I think the anesthiologist (who I knew very well) was trying his best to make things as easy as possible for me. He injected a (very painful) local prior to the IV start, then missed the stick. It took 3 tries to get the IV in. I didn't have the heart to tell him to just do it without the local, so I endured 6 sticks altogether, probably 5 more than necessary. I'll pass on the local in the future!

athomas91 · Apr 11, 2006

most places i have been they use it (only anesthesia can administer it though)... however, i think it is overkill unless you are using and 18ga or bigger. if you are coming in for a boob job and can't handle a 20ga you should just go home...

just MHO

allnurses Guide · Apr 11, 2006

Our CRNA always uses lidocaine before.

My good friend who works in a surgery center always uses it too.

I rarely use it - most of the nurses I work with rarely use it.

I did actually use it today though - on an elderly lady with an IV that infiltrated after 2 days and one piggyback of potassium, which hurt. I was not about to hurt her more.

I guess I should really use lidocaine more.

steph