I've been in the ED for almost 3 years. We give Rocephin IM on a fairly regular basis. I have always asked for an order for lidocaine to reconstitute it instead of using sterile water. I was told by more experienced nurses when I started that it decreased the pain associated with the injection.
We have a new doc who is very nice but when I asked him for lidocaine, he looked very surprised and asked me why would we ever want to do that. He said that lidocaine stings on its own and he thought it would make it more painful. No biggie, I used sterile water but what I really want to know is have I been incorrectly advocating for my patients all this time by asking for a lidocaine order? I understand that lidocaine stings when injected but my impression has always been that it helps as the drug absorbs into the muscle.
My caveat is that this is an informal inquiry - I have not researched this subject. Just curious.
We always use Lidocaine. The order doesn't necessarily even read that way. The pharmacy even automatically sends the Lidocaine.
If I had a STD I hope I would get the best care regardless. As a nurse I try not to judge the people I take care of or their choices. I think it's messed up to give substandard care. Just my very humble opinion!
If I had a STD I hope I would get the best care regardless. As a nurse I try not to judge the people I take care of or their choices. I think it's messed up to give substandard care. Just my very humble opinion!
Specializes in Emergency Dept. Trauma. Pediatrics.
The directions on the bottle say you can use Sterile water or Lidocaine. It might sting initially just the same but it's not as bad after. We didn't have to have orders to use it though where I just was. Doc just ordered the shot and we mixed it how we wanted.
I've never given Rocephin IM. I guess it's just not that common in my neck of the woods. I've given it lots IV, though.
I volunteer for an organization who, with a few exceptions, believes that "If you buy the ticket, you take the ride." I tend to agree with this for the most part.
I always reconstitute with lido, and I don't care if you're one of my unsafe sex patients or one of my SANE cases. I'm not there to judge, and if I can make something less painful for anyone, I always will.
I've had it with and without Lidocaine and to me with Lidocaine hurt worse. When I worked in a dr's office we never gave it with Lidocaine, even to kids.
Oh, Lunah, I was NOT referring in any way, shape, or form to SA victims, nor was I referring to the idea of intentionally inflicting pain in order to teach someone a lesson.
I just think there are some times when there can be therapeutic value in allowing someone to experience the consequences of their own choices. For instance, my daughter threw her cell phone when she was angry about something, and it broke. I would not take her to get a replacement. She had to live with the consequence of her rash decision for a couple of weeks, until she was able to get a replacement on her own.
So, a wild night out with unprotected sex? Now you need a shot that might be uncomfortable? I dunno, I think there might be some therapeutic value there.
Of course, I think if you have the lido available, you should use it. The injection is going to be painful with or without it, and it's a kindness to do what you can to reduce the discomfort experienced by the patient. But I can also see situations where lido is not readily available, and you have to do without. In that case, I think it's fair to warn your patient "This is gonna hurt like a sonofagun, but it's important you get it" and give the shot without the lido.
I think there is probably enough therapeutic value in having to go experience an ER wait and get a shot, either with or without lido. Hahaha!!! For those who are repeaters ... well, apparently a shot is not going to deter them. I've had a patient come in saying he/she needs "a shot and a shake" (which is how we refer to our Rocephin IM and Zithromax 1 gm PO liquid) -- now that is far too familiar!
I didn't think you'd practice punitive nursing, Stargazer. I have read too many of your posts to think otherwise! Sometimes it's tempting, I tell you. I have had my ethics tested here in Afghanistan, and I'm happy to say I found that I provide compassionate care to anyone, even if they'd prefer to pull my 9mm pistol off of my hip and shoot me and all Americans with it. (Can I say I enjoy being an armed ER nurse? Hahaha!)
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Butterfliesnroses
348 Posts
We always use Lidocaine. The order doesn't necessarily even read that way. The pharmacy even automatically sends the Lidocaine.
If I had a STD I hope I would get the best care regardless. As a nurse I try not to judge the people I take care of or their choices. I think it's messed up to give substandard care. Just my very humble opinion!