Starting an IV with Lidocaine or Not?

[hayest]

I recently had surgery. My physician actually started the IV without Lidocaine. He knew I wanted the area numbed before the IV was placed. I've heard the reason before from other nurses and now him..... Lidocaine can hide the vein to cause a 2nd stick. I was willing to risk it. I wanted him to use the Lidocaine and I thought he was. He found the vein, said "here's a stick", (i felt nothing -- thinking this is great), then he said "here's a stick" and OMG .. that hurt like hell. I was VERY upset with him. I haven't had the opportunity to ask him why he didn't use Lidocaine. I know he told the preop nurse that if he could not start it, he would have her do it. I knew he was nervous. Keep in mind, he starts IV's all the time, just not in front of a lot of people. I had everyone leave the room and it was just him and me. Not only do I want to know why he did not use Lidocaine, but why didn't he ask me again and why didn't he give me the chance to ell him that I would allow him to try a few times. He did bring up after starting it "now I know where I can start the IV - next time, we will put creme on your hand to numb it". My reply was "a little late in saying that". What is the consensus of using lidocaine to start IV's or not?

[meanmaryjean, DNP, RN]

To me, the lido hurts as much as the stick. I never use it.

[suanna]

I've had them started with Lido-I can tell you the experience is a lot more pleasant. I've only used it a couple of times myself and think it takes as much skill to use the lido effectively as it does to start the IV. I don't think I did my patients much good in that I've never had someone who is good at lido blocking precept me through the process. Where I work we have the option of getting an order to OK using lido to do an IV start, but most of the resident staff act as if you have lost your mind when you say you want to use lido pre-stick. Our anesthesia dept always uses lido, that is enough to convince me it is a good idea.

[dah doh, BSN, RN]

I work in several departments in my hospital. All the areas need to get a doctor's order for the lido or Emla creme. The exceptions at my facility are pre-op and some of the procedural areas use buffered lido to start IV's as a standard of care. It can be difficult to start IV's after lido because the lido can obliterate the vein. It just takes practice and patience. Usually my patients will tell me, "I didn't feel it" even if I have to dig around. Lidocaine injections burn/sting so we buffer ours with bicarb...it takes out the sting.

[AnthonyD]

I've never seen an IV placed with Lidocaine.

[Anonymous865]

I'm just a patient. Not a nurse. I've had 10 surgeries. (Wow. Never counted them up before!) I've had lots more IVs started on the floor, in the ER, and for various procedures.

Every time I've had surgery, anesthesia has ordered lidocaine for the IV stick in pre-op.

In the ER, on the floor, and for procedures I've never had any lidocaine or numbing cream.

Personally, I'd rather they just start the IV and skip the numbing in pre-op. I usually tell them to just skip the lidocaine. Some places they do. Some places the nurse has to ask permission from the doctor. If the nurse has to ask permission or acts bothered by the request, I tell them just go ahead and use it. I think the swelling caused by the lidocaine is more painful than the IV stick. I'm an easy stick, so that probably colors my perspective.

[Karou]

We have lidocaine spray that we can use for IV insertion. I work on a med-surg floor and we rarely use it. Most of my patients are pleading for "only one stick!" and warning, "you only get one try..." Lidocaine makes it more difficult to insert IV's for me so by using it i am more likely to require a second or third attempt.

The super anxious patients seem to dislike it the same with/without lido because they are distressed over the needle itself more than then actual pain.

Our PICC nurses use it. Anesthesia might but not with most of the patients I have talked to and not when my family members have had surgery.

[KelRN215, BSN, RN]

I've never seen an IV placed with Lidocaine.

Same. I've never even heard of using lidocaine to start an IV on an adult. Don't use it for peripheral IVs in children, either. It collapses the vein and a lidocaine shot hurts way more than a peripheral IV.

Emla is used in children prior to port accesses and occasionally for subq injections but most parents I know don't use it for that.

[JustBeachyNurse, LPN]

Same. I've never even heard of using lidocaine to start an IV on an adult. Don't use it for peripheral IVs in children, either. It collapses the vein and a lidocaine shot hurts way more than a peripheral IV.

Emla is used in children prior to port accesses and occasionally for subq injections but most parents I know don't use it for that.

Exactly. It hurts significantly more and in my family increases the potential for a vein collapse or vein to "blow" 10-fold.

I've used EMLA pre-EMG generally not recommended pre-IV

[Jamariam]

I thought they did away with lidocaine sticks. I've never seen them done in Texas, never

[meanmaryjean, DNP, RN]

The thing is that lidocaine is a drug, has the potential to cause allergic or other reactions- and it costs money. The benefit vs. risk vs. cost is minimal at best.

[klone, MSN, RN]

The lidocaine hurts as much as the IV stick, particularly with a skilled IV starter. So IMO it makes no difference and is just an extra step.