Lidocaine prior to IV start?

Specialties CRNA

Published

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!!!

Here's my take on the situation. Anesthesia is about the relief of pain so I do what I can to begin that process early. If I'm putting in the IV either because I'm at the bedside early or the pre-op nurse needs help, I'll put a little lidocaine in. I always tell the patient what I'm going to do and if they don't want the lidocaine, they don't get it. MOST patients prefer the small sting to the larger IV start. Not all but MOST. There are plenty of times where the pre-op nurse has tried and I am able to get one in (using lidocaine) and the patients express gratitude. This isn't the ER remember, this is pre-op, we are here to provide comfort first and foremost. Some of you are a little dogmatic about what you'll do or won't do. Lighten up a little and use your best judgement. On another note, the common IV site many choose is the lateral side of the wrist. There is often a big vein there. I submit this isn't a good 1st choice. The skin is thick and TENDER there, the radial nerve runs right through that area (there are reports of radial nerve injuries) and the dressing or IV always interferes with my A-Line start.

Specializes in ED (Level 1, Pediatric), ICU/CCU/STICU.

I feel that alot of it for me is personal vs. patient preference. 90% of the time, I'm able to get the IV placed on the first attempt (adult and peds).

I have run into individuals who request "something to block the pain of the stick", and at that point, I'll do a wheel of 1% or even NSS with an insulin syr.

The only issue that I have is regarding people whose veins you really cannot feel, and have a shadow for visual placement. At that point, if a patient would request a sub-q block, I would be hesitant in doing so.

With children, EMLA can be a terrific choice for a sched. line placement, or non-emergency status. Other than that (Peds ER experience), I would mix up some buffered 1%, and off we go. That leads me to my next point. With infants, just poking them with the lido can set them off (combined with the blanket roll / papoose, wow.. such clear lungs your child has), it seems to be better off just restraining them, and give it the first time. If they are older, use the buffered, especially on the hand / wrist.

Just my plugged nickel worth of opinion. :)

That seems really wierd to me , I actually had many IVs never got numbed except for once, only to find out I was allergic to Lidocaine and completley started hallucinating .I some how had the urge to bite everything I saw, even myself:uhoh3: sounds wierd now but at the time I was having complete panic attacks , I would rather take the IV Lidocaine is a big no-no for me !

Specializes in Emergency & Trauma/Adult ICU.
I guess you are forgetting that this is a CRNA forum. Starting their own IVs, CRNAs are not governed by any institutional policy necessarily, but rather by that more universal determinant: what would I want for myself. Some don't, most do.

.

Deepz, I am not a CRNA or other advanced practice nurse, but could you clarify that statement? Policies are policies ... allowed procedures & practices vary among different categories of practitioners, but all are still required to adhere to the P&P, right?

Here's my take on the situation. Anesthesia is about the relief of pain so I do what I can to begin that process early. If I'm putting in the IV either because I'm at the bedside early or the pre-op nurse needs help, I'll put a little lidocaine in. I always tell the patient what I'm going to do and if they don't want the lidocaine, they don't get it. MOST patients prefer the small sting to the larger IV start. Not all but MOST. There are plenty of times where the pre-op nurse has tried and I am able to get one in (using lidocaine) and the patients express gratitude. This isn't the ER remember, this is pre-op, we are here to provide comfort first and foremost. Some of you are a little dogmatic about what you'll do or won't do. Lighten up a little and use your best judgement.

:w00t:

MLOS:

The point deepz is making is that as CRNAs we do not have a p&p manual stating that you are allowed to this or that when starting an IV. In other words when I get a good blood return on a 14g cath but I can't get it to thread many times me or an anesthesiologist will thread a guide wire through the cath and will be able to thread the catheter. These are techniques you will not see in the units and not written in the standard nursing p&p manual. What is applicable to one group of nurses is not necessarily applicable to another based on different levels of practice.

MLOS:

The point deepz is making is that as CRNAs we do not have a p&p manual stating that you are allowed to this or that when starting an IV. In other words when I get a good blood return on a 14g cath but I can't get it to thread many times me or an anesthesiologist will thread a guide wire through the cath and will be able to thread the catheter. These are techniques you will not see in the units and not written in the standard nursing p&p manual. What is applicable to one group of nurses is not necessarily applicable to another based on different levels of practice.

I agree completely. Policies and Procedure manuals are very useful for the accreditation people and to fight some political battles, but I think they are rather useless when you are administering an anesthetic. It may be what separates us from other nurses. When you give anesthesia, you must use clinical judgment on a moment to moment basis and often be able to modify you last decision (the one you made a second ago) because each patient responds differently to the medications we are giving, the surgical procedure and other factors that simply can't be covered in a procedure manual. Whenever we give up clinical judgment, we simply become technicians. We have no protocols, standardized procedures or standing orders, so we must know what we are doing, why we are doing it and how to do it.

Yoga

ICU nurses ( a requirement for CRNA education) rarely start IV's.

I believe that's why CRNA educators stress lido pre stick. They "know" the potential sticker might not be so good and with lido they can dig..

The "requirement" for CRNA education is acute care experience. Many of us come from the ER where we started IVs daily on IV drug abusers in the midst of seizures, chemo patients with one vein left and dehydrated neonates. I can start an IV in a bumpy ambulance, with no light, on a turnip-no digging required. I still use lidocaine.

Please spare us from what you "believe" CRNA educators are thinking. The "A" in CRNA stands for ANESTHESIA-it's what we do.

Specializes in CICU,NICU,L&D,Newborn,PP,OB.

Is there any true technique involving the subcutaneous stick of lidocaine prior to IV catheter insertion, or is it something that nurses try, with the advice of other nurses who happen to be good at it? I do numb my patients, and have good results, I have alot of people asking me to teach them how, but I would like to know if there is a true way that should be taught.

The "requirement" for CRNA education is acute care experience. Many of us come from the ER where we started IVs daily on IV drug abusers in the midst of seizures, chemo patients with one vein left and dehydrated neonates. I can start an IV in a bumpy ambulance, with no light, on a turnip-no digging required. I still use lidocaine.

Please spare us from what you "believe" CRNA educators are thinking. The "A" in CRNA stands for ANESTHESIA-it's what we do.

why would you use lido in the back of a rig---? my thoughts on this are basically my thoughts on most things. rn's need only assess the situation. if lido would be appreciated/warranted USE IT. if not, don't. i for one customize my practice to the situation. lido is easy and fast but in my experience it's the fear of the needle that people object to--and in the case of lido you are giving them two needles to object to and that's if you are in on the first try. hey in the ER we are all experts; but all of us can miss on that dehydrated 100 year old or 300 lb diabetic; in the case of infants and children--it's widely understood that their issue is fear and being held down--get to it and make them better asap. if i was prepping for surgery or some otherwise scheduled case, i'd do what i always do--collaborate with my patient--if they are unable to do so i make my best judgement--but i certainly consider it.

Specializes in ER/PDN.

I work in the ER

I like to use lidocaine when I stick most people. Mostly kids and younger adults. The older adults don't seem to want it but the younger do. My docs always okay it. I use a 27 guage needle. There are people against it because They think I am too nice. I would rather have the little stick than the big stick of the 18 guage needle. Some don't like to use it because they are not not familiar with the technique. I was scared at first but once I got used to it, it came easy. I use EMLA on littler kids.

.

Just wondering if it's legal to the scope of practice for an RN to use lido or 0.9NS intradermal for this purpose without and MD order? Also....I've NEVER seen this at my facility......do you make the wheal directly above the vein you intend to use and start the IV down through the wheal.....or next to the wheal...??? What's the procedure? And how long do you wait if you are using ID lido??? ID NS??

+ Add a Comment