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?
On adult patient it wouldn't matter if you injected the whole 1-3+mls of lidocaine into the vein or not. The maximum safe dose of lidocaine is 4mg/kg without epi. Most concentrations of lidocaine come in 10mg/ml or 20mg/ml for a 70kg patient that would be 280mg. We inject 100mg IV lidocaine all the time in anesthesia to blunt the sympathetic response to intubations. I might not suggesting you inject the lidocaine on purpose into the vein, but if you inject a couple drops or a whole ml or 2 it isn't going to hurt anything.
Now saying all that: Lidocaine does not have to obscure your view. You can make the lidocaine bleb slightly more distal than where you would normally start the IV and go through the bleb aiming towards the vein. Also, if you are using bicarb with lidocaine the mixture is 1/10 bicarb and 9/10 lidocaine. This mixture only works with lidocaine, if you try this with bupivacaine it will precipitate.
Here is my recommendation for new nurses/techs starting IVs: Most people have a decent size vein that runs parallel to the bone of the ring finger/metacarpal, and most of these people will have bifurcation that comes into one vein on the distal portion of the metacarpal. The best way I have found is to insert the IV slightly before the bifurcation, go through the bifurcation, and into where the vein makes one large vein. At least initially you should go fairly slow, when you get flash stop for just half of second, and then advance a couple of more millimeters into the vein. This technique will help you find one of the more common vein sites, and help with a common problem of not being able to advance the IV catheter d/t valves. For more advanced IV starts the mid forearm is one of the best places (as far as comfort and ease of maintenance) to start an IV. There are fewer valves in the mid-forearm, the veins tend to be straighter, but they also tend to be deeper and can be a little harder to get flash at first.
I'm a new grad, working on an inpatient oncology unit. Our policy states we are to use 0.1cc of lidocaine before each IV start. Most of our patients, that don't have a PICC or a port have crappy veins because they're stuck so often. I am by no means a master IV starter, but the ones I have been unable to get have all been without lidocaine.
Even the nurses on the floor that are the ones we go to when we can't get a stick (aka "the ones that can throw one in from the door") have had issues starting IVs when they use lidocaine.
wtbcrna, MSN, DNP, CRNA
5,128 Posts
On adult patient it wouldn't matter if you injected the whole 1-3+mls of lidocaine into the vein or not. The maximum safe dose of lidocaine is 4mg/kg without epi. Most concentrations of lidocaine come in 10mg/ml or 20mg/ml for a 70kg patient that would be 280mg. We inject 100mg IV lidocaine all the time in anesthesia to blunt the sympathetic response to intubations. I might not suggesting you inject the lidocaine on purpose into the vein, but if you inject a couple drops or a whole ml or 2 it isn't going to hurt anything.
Now saying all that: Lidocaine does not have to obscure your view. You can make the lidocaine bleb slightly more distal than where you would normally start the IV and go through the bleb aiming towards the vein. Also, if you are using bicarb with lidocaine the mixture is 1/10 bicarb and 9/10 lidocaine. This mixture only works with lidocaine, if you try this with bupivacaine it will precipitate.
Here is my recommendation for new nurses/techs starting IVs: Most people have a decent size vein that runs parallel to the bone of the ring finger/metacarpal, and most of these people will have bifurcation that comes into one vein on the distal portion of the metacarpal. The best way I have found is to insert the IV slightly before the bifurcation, go through the bifurcation, and into where the vein makes one large vein. At least initially you should go fairly slow, when you get flash stop for just half of second, and then advance a couple of more millimeters into the vein. This technique will help you find one of the more common vein sites, and help with a common problem of not being able to advance the IV catheter d/t valves. For more advanced IV starts the mid forearm is one of the best places (as far as comfort and ease of maintenance) to start an IV. There are fewer valves in the mid-forearm, the veins tend to be straighter, but they also tend to be deeper and can be a little harder to get flash at first.