Lidocaine prior to IV start?

Specialties CRNA

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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!!!

My husband had lidocaine used on him to start an IV then to anethetize the area. He had a seizure. Our ER does not use lidocaine for IV insertion ever.

I don't think it was just me.... your wording here (combined with topic of this thread) really seemed to say the seizure was from the lidocaine used from an IV start. When read in combination with your last statement, it seems to imply that lidocaine is unsafe and causes seizures.

Thanks for finally clarifying.

Specializes in M/S/Ortho/Bari/ED.

Shouldn't it be left up to the patient to decide as long as it isn't an emergency? After all, it IS their arm being stuck....why shouldn't the patient be able to choose? I know I really appreciated the lido when I got stuck. They are scared and anxious and it only takes a few extra minutes to make it easier for them....maybe I'm too green, still! :D

Again, it all depends on circumstance. When a patient has marginal veins, if I can give lido without fear of obstructing my sightpath, I will. If I have a guy with veins the size of the Holland tunnel in his arms, I won't. If

I can get it in in 2 seconds, IV's just DON'T hurt that much. Over and done with, distraction techniques afterwards; and they have forgotten all about it.

I got really annoyed when the DON of my last position "ruled" that ALL patients had to have a lido wheal before IV starts. There is no outstanding research to point pro or con; and when I gave her the results of my literature search, she backed down quickly.

Cate

Specializes in Geriatrics/Oncology/Psych/College Health.

on a board of this size, one may safely assume that not every post is read by the moderators. rather than responding to them, please report objectionable postings before a thread needs to be closed. foolishly, one may also assume that a thread about using lidocaine for iv starts wouldn't spiral down. i would ask everyone to be aware of the practice differences between rn's/lpn's and crna's. i would hope posters wouldn't abandon the board d/t legitimate professional disagreements over this topic.

I have clinicals at a site that requires the use of Subdermal Lidocaine prior to IV insertion. The people in my study group each had an IV started by each other with the lidocaine and it was wonderful. It took effect immediately and took away the anxiety I've always had about IVs.

Now, I will say it sometimes makes it harder to get the IV started...especially if you push too much of it. But, what a relief to the patient!

Specializes in BICU,PICU,Rural ICU,Float ICU,IV Therapy.

I was an ICU nurse the past 5 yrs recently turned IV Therapist. The answer is ask the patient. We generally use a small bleb of bacteriostatic saline like giving a TB shot prior to starting a peripheral IV. It numbs the top of the skin and doesn't burn like lidocaine. Some patients would rather have just 1 poke and skip it all together. It's a personal preference thing.

I have had many IVs over the years and I have never had Lidocaine before hand. Maybe it's just me, but I didn't think that it was so bad and I have very tiny veins. I have also had Lidocaine during procedures to provide local anesthesia and I think that the burn from the Lido hurts more than the IV stick. Just my :twocents:.

Specializes in CRNA.

I agree 100% with your professor, and have had the very same conversation with many new SRNAs. Once you get the hang of doing an intradermal injection of the 1% lidocaine, the patient should feel very little. It has to be an intradermal injection though, not subcutaneous. What never ceases to amaze me is how many times the person who called me to start the IV that they could not start, then tells me that the local injection is unnecessary, another stick, makes the vein disappear, etc, etc, etc. Well, I think it makes a difference and have pretty good success at difficult IVs. It makes it easier on the patient, and easier on me if the patient is not flinching every time. An unintended consequence is there are patients that get wise and start insisting that anesthesia is called to start their IVs.

There is almost NO reason NOT to use lidocaine before starting an IV.. The lidocaine will accoplish several things.

1. Attenuates the pain of the 18 or 16 Ga catheter or even 20 ga.

2. The patient has no idea how you do anesthesia.. if you are very skilled or not.. the ONLY thing they will actually see YOU do as a CRNA, is start the IV. They will judge your abilities based on that interaction.

3. Vascular tone is determined by innervation... local anesthestic inhibits nerve transmission by its action of ,IIRC , Na channels. You interrupt the nerve transmission and you get vasodiliatation. Remeber the person you are starting the IV on is not only dehydrated... NPO..... and nervous...adrenal output.

4. On the occasional true " difficult stick" if the first one does not hurt.. they are more amenable to letting you try more than one.

Not to be rude.. but.. if you do not do anesthesia you should not be giving advice to an SRNA.

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