Painful IV starts and your hospital policy

[daisey_may]

Hi,

I am currently starting a project for my BSN that will hopefully be able to made policy at the hospital I work at.

At the hospital where I work, there is no policy about offering any pain alleviation prior to an IV start. Many of the hospitals in my area already have a policy in place. It seems that lidocaine prior to starting an IV is used in some areas of the hospital and not in other places.

Does your hospital have a policy? What do you use for pain relief and what are your feelings about using and offering it? Do you consider it a standard of care to offer pain relief prior to an IV start?

This project is in it's early, early stages of research and from discussing it to other co-workers, I've had mixed feelings about implementing a policy and I'm curious how other nurses feel about it, too.

Thanks,

Daphne

[EmmaG, RN]

We sometimes used EMLA prior to port and (difficult) peripheral starts. It wasn't policy, it required a doctor's order.

[wooh, BSN, RN]

Policy is EMLA or LMAX is offered for all sticks. (We used cold spray too, but there was a recall on it, and haven't seen it back since the recall. And babies get sweetease instead cream.) We're a peds hospital though. For the quick sticks (like lab draws) I sometimes wonder if it's worth it though. The kids get mad and upset when you go put the cream on, then they're so mad we're holding them down, I wonder how much difference that little stick is making. Almost seems cutting out the first time upsetting them with putting on the cream would make up for the little added upset of the pain of the stick. Especially when you consider, that it hurts pulling off the tegaderm holding the cream on. (Of course if you put cream close enough to the edge that it won't pull, it leaks out then parents freak out that the cream is leaking. So you've got freaking out kids and parents.)

[jmgrn65, RN]

our policy is that a lidocaine weal can be used, I personally don't use it. IMHO it is just another stick. I have had it used on me and I would just as soon get the iv without the lido. we can use emla cream but it requires a doctors order.

[caroladybelle, BSN, RN]

our policy is that a lidocaine weal can be used, I personally don't use it. IMHO it is just another stick. I have had it used on me and I would just as soon get the iv without the lido. we can use emla cream but it requires a doctors order.

Same here. And for that matter, the lidocaine invariably burns more than a plain stick.

It may not ever be used again for me. The last time, I developed a panicky feeling and some serious tachycardia for an extended period right after being injected. Anyone ever hear of that?

[jmgrn65, RN]

Same here. And for that matter, the lidocaine invariably burns more than a plain stick.

It may not ever be used again for me. The last time, I developed a panicky feeling and some serious tachycardia for an extended period right after being injected. Anyone ever hear of that?

yes I have heard of that before, have you had novacaine before (you know like at the dentist) just curious.

lidocaine does burn.

[PRESLA]

] I have a hard time starting an IV s lidocaine LOVE being able to numb the site and I think any facility or nurse who does not use or offer numbing is doing a dis-service to the patient!!!! If you buffer the lidocaine c bicarb it does not sting

Lisa

[wibobr]

Our hospital policy is BUFFERED Lido. I personally prefer a refrigerant spray. (Does not distort the site)

[RedCell]

Sounds like the lidocaine you were injected with was mixed with a little epinephrine and it went intravascular

It may not ever be used again for me. The last time, I developed a panicky feeling and some serious tachycardia for an extended period right after being injected. Anyone ever hear of that?

[TazziRN, RN]

Red, not unheard of.

I've used epidermal lido for years. I don't use it on a regular basis unless the pt asks for it ahead of time, but I have no problem using it. Yes, it is another stick. Yes, unbuffered lido burns a lot. BUT.....I've found that the people who request it after having it used successfully in the past aren't afraid of the needle itself, it's the digging around if the start is difficult.

[NursesRmofun, ASN, RN]

No policy. If the patient has pain and/or is a difficult stick, they can ask for, or we can suggest, EMLA and there is an order taken for it.

[eandgsma]

Our policy is Lidocaine ID prior to IV start. I haven't had anyone complain about two sticks. I just warn them that they will feel a stick and a burn, then I will start the IV. I also warn them not to watch, lol! In OB we use 18G IVs and lots of times they are more freaked out about the size of the needle vs the actual stick. I also always tell them that there is only a plastic catheter in the vein now and no needle. That seems to make them feel better too.

- N