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!!!

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??

No - you must have an order, whether it's a standing order or one-time order. You make the wheal exactly where you plan to enter the skin with the angiocath. The effects of subcutaneous lido or NS are almost immediate, so when you get rid of your sub-q needle, you are ready to place the angiocath.

Edited to say: This is in my state, Ohio, and meant for staff RNs. This does not apply to RNs with advanced practice licenses.

Specializes in ER/PDN.
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??

No you must have an order. Most of our docs Give us a verbal order or written, some it is a standing. I make the Wheal right above the vein. I do warn the pt that it may flatten the vein and make it harder to access. I just wait about 10-15 seconds with the lido and then stick. Most do not feel it. I use about 0.1-0.5 ml depending on the person. just enough to make a bubble. I use a 27 guage needle.

No you must have an order. Most of our docs Give us a verbal order or written, some it is a standing. I make the Wheal right above the vein. I do warn the pt that it may flatten the vein and make it harder to access. I just wait about 10-15 seconds with the lido and then stick. Most do not feel it. I use about 0.1-0.5 ml depending on the person. just enough to make a bubble. I use a 27 guage needle.

Jayne,

You need to check you facts before posting on this forum. There are state boards of nursing who have approved RN administered local prior to IV insertion without a doctor's order.

Also, although you mean well, your information is more appropriate for a forum other than this one. CRNAs do NOT need orders to do any anesthesia related activities and our education and practice is just different than other areas of nursing.

Yoga crna

yoga crna,

This topic pops up in active topics on the nursing board. And non-crna's read it. (It's allnurses after all, not allcrnas.) Just like when a topic in ER or OB or M/S nursing pops up that attracts nurses outside that specialty from the active topics pages. No need to be so territorial.

Thanks for the info...... I'm def. not a crna yet so I will need the docs order to do this..... crna is in the future though....can't wait.

yoga crna,

This topic pops up in active topics on the nursing board. And non-crna's read it. (It's allnurses after all, not allcrnas.)

It is your duty (and everyone else's) to realize who's specific board you are posting on before spouting off. CRNAs have a different playbook and MO than do staff RNs.

Don't hate the player, hate the game.

Specializes in ER/PDN.
Jayne,

You need to check you facts before posting on this forum. There are state boards of nursing who have approved RN administered local prior to IV insertion without a doctor's order.

Also, although you mean well, your information is more appropriate for a forum other than this one. CRNAs do NOT need orders to do any anesthesia related activities and our education and practice is just different than other areas of nursing.

Yoga crna

Sorry.

It is your duty (and everyone else's) to realize who's specific board you are posting on before spouting off. CRNAs have a different playbook and MO than do staff RNs.

And she was replying to a staff RN, unless a CRNA all of the sudden got confused and thought they would need an MD order. Like I said, no need to be so territorial about a thread. If a few more patients get some lido before an IV start because a *gasp* staff RN posted to a CRNA thread, in the end isn't that more important than keeping a thread pure and clean of any non-CRNA involvement?

If you're so worried a mere staff RN might use your thread to learn something, find a private forum or petition to make this one member only. Telling people not to "spout off" when they're trying to share knowledge that pertains to the topic at hand (even if not the forum at hand) is just childish.

I think I have become a burden to this board and will sign off and unsubscribe. While I love to mentor the young CRNAs and learn from all of you, it appears that I seem to offend many. Also, my interests are more to CRNA clinical and professional issues and I can find them on the various yahoo groups for nurse anesthetists.

It used to be fun.

Bye.

Yoga CRNA

I think I have become a burden to this board and will sign off and unsubscribe. While I love to mentor the young CRNAs and learn from all of you, it appears that I seem to offend many. Also, my interests are more to CRNA clinical and professional issues and I can find them on the various yahoo groups for nurse anesthetists.

It used to be fun.

Bye.

Yoga CRNA

Yoga,

I will miss your postings. I find you objective and insightful. I know where I'm going to go now for CRNA school. You take care---BREATH and STRETCH. You will be missed AND you made a difference for ME! I'm going to sign off too. I agree too much with the, (why are nurses so catty?) thread, and it creates too much negative energy to reply kindly in any meaningful way. Besides, I HAVE TO STUDY:)

Regards,

9lCRN

Wow.... That's the most childish and rediculous turn of events that I've ever seen unfold..... ever. And I'm the young one here.

it is sad this was a great thread until it got out of control. Guess the moderators were sleeping. 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. Kids or not

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