Lidocaine air injectors for children

[Training1]

Does anyone know where I can purchase a lidocaine air injector and is it safe to use on the anticubital area before an IV start. I work with children and I would like lessen pain and trauma when doing IV starts and lab draws esp for those who are "hard sticks". I'd like to inform my hospital of this product and how to acquire it, any input would be greatly appreciated.

[anon456, BSN, RN]

We use disposable ones-- not sure if you are talking about those or if there is a non-disposable kind available.

My feedback is as follows:

1) It makes a loud hiss that often scares the patients. Especially the babies, the neuro kids, and those who are nervous about an IV stick (so that's almost everyone). Even if you warn them and make it sound fun. We say it's a "rocket ship."

2) It doesn't work all that well. Some RN's swear by them and that's great. But when I have seen or used them, the kids still flinch with the poke and try to pull away. Those that are able still say "owie."

3) It can make veins disappear. Especially on the hard sticks. The trick is to do it next to the vein, not on the vein. But even then sometimes a vein will disappear or be hard to thread after the J-tip is used. And yes it's okay to use with AC veins. Pretty much anywhere but the head/face area.

4) It can spray people if not pressed down firmly during the application process. Easy to do if a kid pulls away quickly or they are chunky and it rolls on the skin.

But like I said a lot of people really love them. And maybe there is a better way to use them that I don't know about.

[Esme12, ASN, BSN, RN]

I have never liked it...I think it blanched the site making nit difficult. When I do use it I prefer EMLA...a topical application. Takes longer but less traumatic.

It costs money....and something I am sure your acility is aware of and chooses not to use.

[anon456, BSN, RN]

I have never liked it...I think it blanched the site making nit difficult. When I do use it I prefer EMLA...a topical application. Takes longer but less traumatic.

It costs money....and something I am sure your acility is aware of and chooses not to use.

Esme, do you find that EMLA blanches the site? I have suggested using this on the patients who can afford to wait some time for an IV to be put in/replaced, and have been discouraged. They say it blanches it too much and the veins are hard to see or get. I have used it with IM injections-- but it doesn't work that great because they go deep and the med hurts. :-( Sometimes there's just no easy way to avoid hurting patients.

[Esme12, ASN, BSN, RN]

I have to say I don't like it.....it there is ANY doubt about the site at all....the veins disappear and the site blanches making it IMHO more difficult. I will use it sometimes IF the family insists.... on the anticub...but I don't like it at all. Any dehydration and I think it makes the site harder to get. I also find they are going to scream from the moment of the application of the tourniquet until you are done....EMLA or not.

I really find taking the time to explain the IV show them when you are done that all you are leaving is a soft plastic straw...I show them the angiocath....I removed the needle and the brush the catheter on their arm to show them how soft it is they cooperate more. I tell them to scream if they want but don't move.

I find the parents are the ones who need the comfort not the child. I KNOW many kids have had bad experiences and have endured many sticks....but I think these products make an unsuccessful poke more likely...but I am more accustom to not using it for many time the IV is emergent and there isn't time.

I find a little subQ lido works best if you can get the clearance from the practice committees. But it involves another poke...sigh...no sometimes what we do hurts and that sucks....

[WoosahRN, MSN, RN]

I've had some kids that like it and ask for it so I'll use it with them. Even if it's mental, it makes for a better experience (and some do say it helps). I don't use it on everyone, and when I do, I use it next to vein. But I've had older kids who shrug their shoulders and could care less since it didn't really help them. Then again, they aren't the ones who are kicking and screaming.

I tell them it sounds like a soda can and wrap my finger around the bottom so no one gets sprayed.

I'd spend some money on an Accuvein light. I love those things! We have one on our unit. When I was doing Internet searches I found some glasses that I'm interested in trying. Wish we could trial those.

[Asystole RN]

We use a cold spray for a pain control with good effect.

The nice thing about cold spray is that it is relatively cheap, non-invasive, does not disrupt the injection site, it is quick, and does not involve medications.

[OCNRN63, RN]

I have never liked it...I think it blanched the site making nit difficult. When I do use it I prefer EMLA...a topical application. Takes longer but less traumatic.

It costs money....and something I am sure your acility is aware of and chooses not to use.

The one facility where I worked had us inject lido subdermally next to where we were going to start the IV. For most pts., it made the IV start less painful. I don't mind IV starts, but I could def. tell the difference.

[KelRN215, BSN, RN]

I don't find Emla useful for anything other than port accessing or shots. We used to use synera patches for IV starts/lab draws. It takes like 20 min but supposedly was better at not making veins disappear. In a lot of kids I think these kinds of things can actually make the process worse- gives them another 20 minutes to perseverate on what's coming. I have a 3 yr old whose parents don't use Emla on his port for this reason- they feel that he flips out either way and with Emla, he knows it's coming and it makes it worse.

[Kunzieo]

We use both the J-tips (lidocaine injectors like Anon456 was talking about) and Synera patches (lidocaine/tetracaine medicated patches.)

For almost the same reasons Anon described, I HATE the J-tips! They're loud, messy, can blow the vein or just make it disappear, and are pretty frightening to smaller kids. Adolescents like them, though.

I LOVE my Synera patches. We slap 2 on each kid (in case we aren't having a lucky day.) the older kids like it because it's non-invasive and easy for them to understand. The parents of small kids like it because it makes them (the parents) feel better. Although it's quite important to explain to these parents that their 2 year old is going to cry, despite all the Synera in the world!