Lidocaine prior to IV start?

maturner · Apr 11, 2006

I started IV's for 4 years in the ER without local.... that makes me shudder now that I know how to do it with anesthesia. In fact, I think it is MEAN to do it without local. It ABSOLUTELY makes a huge difference to use lidocaine. I add a little bicarb.... so stinging is really not an issue. If you use a 30 guage needle... it really makes the whole thing almost painless. If you have good technique, this should not make the IV start more difficult for you.

Ditto. I initially started missing IVs that would have never missed, without the LA in the way, but with practice and improved technique no worries.

midwestsrna1 · Apr 11, 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!!!

At the start of our program, we got a lecture on always using local with PIVs. The next week, one of the students who was a very experienced nurse was spending a day in IV therapy and successfully placed an IV without local on one of the hosptial's CRNAs who she hadn't met yet. Of course, we all got another lecture. I always offer it to the patient, they can have 1 stick or two (hopefully not feeling the second).

I used to hate using local and do think in some situations, it makes it harder to get the IV (some patients, the second any needle hits the skin, the vessel seem to spasm or disappear - there are the pts local isn't helpful on). However, if you give it time to work, it should actually cause a small amount of vasodilation to the vein (mini-sympathectomy at the site). In addition, the prime advantage of adding bicarb, aside from the burning, is that pH > pKa thus lidocaine, a base, will have a greater percentage nonionized and thus faster onset. This is the same reason people add bicarb to some regional anesthetics.

MmacFN · Apr 11, 2006

this is an interesting discussion

Depending on where im working (and the clinical situation), i use lido or i do not.

When my patient is quite sick, i dont use the lido, like in the ER or a crasher in the CV or aircraft. When I work in the PACU or CCU and my patient simply needs another IV i use it all the time. This was taught to me in nsg school as a general rule when avaliable and we started IVs on each other with and without lido.

Good info!

tvccrn, ASN, RN · Apr 11, 2006

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.

A central line is different from a peripheral. I don't use lido for a quick IV, I have a problem with the site blanching and then not being able to see what I am trying to hit. A lot of the time I can usually feel what I am going after, but on the LOL's that's not always the case.

tvccrn

wooh, BSN, RN · Apr 11, 2006

So why any needle at all? Why inject lido over using topical EMLA or LMAX?

WVUturtle514 · Apr 11, 2006

So why any needle at all? Why inject lido over using topical EMLA or LMAX?

When we used EMLA on our peds patients in the ER, it usually took about 15-20 minutes to get the full effect. This just doesn't really seem feasible in the OR setting, unless you have a ton of time on your hands. But then again....I'm still a newbie.....

NephroBSN, BSN, RN · Apr 11, 2006

I am very curious about your allergy to lidocaine. True allergies to amide local anesthetics, such as lidocaine are very rare. I did a Medline search and found no references of such an allergy. Could you have had a reaction to the epinephrine in local used in dentistry? Some people get a CNS excitation from an overdose, but this is not an allergy. I would love to have more information.
Never too old to learn new information.
YogaCRNA

My "allergy" to lido is the fact that I hate it. I hate that small needle. It hurts and I'm not talking about the lido sting. I think a small needle hurts more than the bigger one.

Remember I use 15's all the time. Well once in a while 17's. We discourage the use of lido because it causes scar tissue around a graft or fistula.

Yes, I know we stick them three times a week.

Drug addicts in the back alley's don't use lido.

I hate needles just the thought of getting stuck scares me. So one is enough.

Interestingly, I've never even been offered it at any Red Cross blood drive.

What gauge needle to they use. 16 or 14?

We got rid of lido on the M/S floor because it can be a dangerous drug to have sitting around.

JMHO.

ahsitters · Apr 11, 2006

I just had my first IV insert with lido when I had my third baby 3 months ago and It was a million times easierfor me. I am a hard start and this made all the difference. I will never insert an IV in one of my patients with out lido again. If I can prevent unesessary pain I should. I also have re thought my position on topical lido for catheter insertion as well. When we know better we do better.

NephroBSN, BSN, RN · Apr 11, 2006

I just had my first IV insert with lido when I had my third baby 3 months ago and It was a million times easierfor me. I am a hard start and this made all the difference. I will never insert an IV in one of my patients with out lido again. If I can prevent unesessary pain I should. I also have re thought my position on topical lido for catheter insertion as well. When we know better we do better.

What catheter insertion are you talking about?

Central catheter????

London88 · Apr 11, 2006

I always use lido on pts in the OR as well as when i get called to the floor to do a difficult stick. The pts always appreciate the lido. I routinely get asked is done already? Only because the pt did not feel the bigger needle going in. I will admit that it does get a little bit of getting use to at first.

Focker, CRNA · Apr 11, 2006

I work in peds and this is not a common practice... There are some kids that we use it on but very rarely do we.
ELMAX acts as a vasoconstrictor and if we are putting it on the site it acctually makes it harder to get an IV in the kids... and when we have babies and such they already have tiny veins I know it sounds evil to enforce the pain... but most times it does more harm than not.

I dont know of any vasoconstirctor properties for EMLA (lidocaine and prilocaine are the active ingredients, correct?), if anything I would think it might vasodilate, like someone else said, similar to a minisympathectomy. The only local anesthetic that has vasoconstriction is cocaine. Is ELMAX different from EMLA cream, just a misspelling (someone else mentioned LMAX), or a brand name?

susswood · Apr 12, 2006

ELA-MAX or (LMX) is similar to EMLA but it is 4% Lidocaine plain (no prilocaine-so it is safer becuase of the decreased risk of methemoglobinemia in little ones). It is supposed to work faster than EMLA cream (about 15 minutes vs 30 minutes). I have used it on myself and my son and it works very well. No, it does not vasoconstrict, but it does blanch the skin a little. I heard you can now get it over the counter.