Quick question about IV starts.

[CrazierThanYou]

Hello, I am starting nursing school in August and I am a bit apprehensive about starting IV's. I was watching a YouTube video of a nurse starting an IV and at the end of the video, she mentioned that before starting, the IV site can be numbed with lidocaine to reduce pain.

A while back a friend of mine was in the hospital and needed an IV started. She requested the nurse numb the site and the nurse refused, saying it was against hospital policy because it made it more difficult to get the verin.

I am just curious about whether there is any truth to that? Can using an anesthetic make the vein harder to get?

[brownbook]

In very rare circumstances a small welt of lidocaine injected prior to the IV

[K+MgSO4, BSN]

starting an IV is minimal in the pain scale compared to some of the interventios you will perform on your patients. Removing a Jackson Pratt drain for example. Imagine forcing a square peg out of a round hole. Sitting a pt out of bed on the first day post op and making them cough and deep breath. inserting a wide bore rhyles tube down someone's nose to alivate faceal vomiting. Lying across your agitated and combative patient so that she can be shackled for her own safety.

So you see starting an IV is peanuts! I know it is something that many students fixate on but it is so minor that it doesn't even light up my pain inflicting radar!

[flashpoint]

There are some creams that have a numbing effect, but most of them take quite a while before they are effective. In my experience, lidocaine burns initially, so injecting it seems silly...I would rather just have the IV stick and get it over with.

[sunnycalifRN]

Starting IV's is just a task . . . one that you will learn to do with both hands tied behind your back!! Don't worry about it, it will become second nature.

As far as using lidocaine . . . it does not make finding the vein any harder . . . on those rare patients that are extremely sensitive to pain, e.g., scream when you do a fingerstick . . . then, sure, you can use lidocaine, if you get an order.

In nursing school, we practiced IV starts on each other . . . it's actually great because you'll know, firsthand about the pain you'll be inflicting when you do IV starts . . . and, talk about crappy IV starts . . . I shudder when I think about it!!

[skipaway]

I use Lidocaine on a daily basis. Sometimes, rarely, it can obscure a small vein and make the stick more difficult. I find probably 99% of patients are grateful to get lidocaine. I sometimes add Neut (bicarb) to the Lidocaine and it then doesn't burn at all. But truthfully, as someone who has received Lido for an IV start, it barely burns at all.

Lidocaine is a medication. You need an order to give it and usually, the hospital system does not have 1 doctor to give an order encompassing the entire nursing staff.

[brownbook]

My reply got cut off. The small welt that the lidocaine makes can very rarely cause problems. Thin skinned elderly patients sometimes bleed or bruise as soon as the welt is made. Sometimes the welt obscures the vein right where you plan to start the IV. I wonder of the hospitals policy is more concerned with accidentally injecting lidocaine into the vein instead intradermal? Many excellent IV nurses swear by lidocaine. Many excellent IV nurses swear by not using lidocaine. The lidocaine does sting. I hate to read "don't worry, IV's will become easy." To me that puts more pressure on a new nurse. For some new nurses it isn't so easy and their performance anxiety goes through the roof when they read "you'll do it with both hands behind your back." They beat themselves up when they blow it, get more anxious, blow it some more, get more anxious, etc. Some nurses have the knack, are great right out of nursing school and never look back. Some nurses blow some, loose all confidence, and look for jobs where they won't need to start IV's. However I do believe starting IV's can be mastered by all but a few nurses.

[RingER]

You can grab a product called hurricane spray that is typically used to numb the back of someone's throat and it can help a tiny bit. It's only topical though and so the IV start can still hurt a bit. Try to avoid sensitive areas if the person is extremely pain or needle phobic. Hands, wrist, and sometimes low forearm will hurt more. AC is more just a mental thing, same with bicep.

Mostly just talk the person through, worse case if they have to have it and won't hold still, get help to hold and make it quick. Also, make sure they understand that no needle stays in their arm, it's just a flexible plastic tube. So many don't understand this.

[kmoonshine, RN]

There is a topical cream with lidocaine that works wonders, but as other have said, it takes quite a long time to work (I put the cream on thick over the potential IV site and cover the cream with a transparent dressing; I then put a warm compress over the site to increase absorption...but even with this it can take more than 20 minutes to get the site nice and numb). I use this topical cream for pediatric patients when I anticipate that they'll need an IV.

I have never used lidocaine injections to numb an IV site, but I hear that it can burn (as others have stated, you can mix it with bicarb to lessen the discomfort). When you inject the lidocaine into the skin above the IV site it forms a bump called a welt, which can make it harder to see the vein when you are ready to start the IV.

A nurse that knows what they are doing and who can start an IV quickly tends to cause very little pain.

I avoid starting an IV in the patient's hand since it tends to be more painful.

[Work in Progress]

The hospital where I am doing my preceptorship uses lidocaine for every IV stick per hospital policy. This is a new QI initiative, so I just read all of the literature provided when they started the policy. Apparently, the lidocaine can cause some vasoconstriction (not sure about the reason on this) so it can make a small vein harder to stick. I agree that an IV stick is minimally painful, but their patient satisfactions scores have gone up dramatically since the policy took effect in January. The lidocaine order is linked in the computer to the admission orders, so getting an MD order is not an issue here.

But don't worry about starting IVs. I think everyone has some anxiety around poking large needles in people, but it really does become commonplace after a while.

[CrazierThanYou]

I appreciate everyone's answers and input on my question!

I also appreciate the reassurances about starting an IV. I have no qualms about giving shots or anything like that but the IV gets me. Maybe because, for me, the IV's were the worst part of childbirth!

[Crux1024]

Emla (spelling?) cream maybe? I know its mostly used in peds, but IDK if it would be helpful for adults as well. I do know it takes a little while to be effective.

Sometimes when IVs are needed right away, theres no time for lidocaine orders or looking for hurricane spray (id have to rob the endoscopy unit...lol.). If an IV stick is all a pt has to worry about then lucky for them.