Starting an IV with Lidocaine or Not?

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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?

Specializes in LTC Rehab Med/Surg.

We don't use it where I work, but I was an inpatient a couple of years ago and the nurse there used Lidocaine.

The first time, the second time, and finally I just told her to forget the Lidocaine. Double the needle sticks.

It hurts when you're poked with sharp objects. In a perfect world you'd get the Lidocaine, then the IV, with reduced pain.

That doesn't work out for everybody.

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Specializes in CVOR, CVICU/CTICU, CCRN.

I've been told by enough patients that they didn't feel anything with an IV start that I don't bother with the lidocaine. I typically will rub the crap out of the skin with alcohol swabs to exhaust the nerve endings - by the time the needle enters the equation the area's pretty much numb. I've heard emla cream is pretty hit-and-miss as far as pain prevention goes, and lidocaine is just another needle to worry an anxious patient with (read: higher risk of accidental needle-stick).

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Sorry but the lidocaine stick does not hurt as much as getting an IV. I refuse to let them start one until they do the lidocaine stick. The pain from an IV is horrible IMO. Not a problem at the one hospital I've had all my surgeries at-the ER automatically uses the lidocaine and so does pre-op. That's why I don't go to the other hospital system in my city.

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Specializes in Neuro ICU and Med Surg.

I have never had a lidocaine injection prior to an IV start. I wouldn't let staff do it either. Lido hurts WAY WAY worse than any IV stick I have ever had.

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Specializes in Pediatric Critical Care.

In pediatrics we use EMLA cream, and the J-tip, which is a needle free subcut injection of lidocaine. Its a neat idea....but it makes a loud pop/hiss, like opening a can of soda thats about to explode. A lot of kids who are ALREADY scared of the IV poke get scared by the noise of the J-tip as well.

I personally dont prefer using J-tips on my patients because it seems to make the vein constrict and suddenly that vein you thought was so good is totally gone. EMLA is alright....if you have 30 minutes to sit and wait to start the IV, which is often not the case. Bottom line is that unfortunately, geneally kids aren't gonna enjoy their IV start experience, even if its 100% pain free.

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Specializes in Pedi.
In pediatrics we use EMLA cream, and the J-tip, which is a needle free subcut injection of lidocaine. Its a neat idea....but it makes a loud pop/hiss, like opening a can of soda thats about to explode. A lot of kids who are ALREADY scared of the IV poke get scared by the noise of the J-tip as well.

I personally dont prefer using J-tips on my patients because it seems to make the vein constrict and suddenly that vein you thought was so good is totally gone. EMLA is alright....if you have 30 minutes to sit and wait to start the IV, which is often not the case. Bottom line is that unfortunately, geneally kids aren't gonna enjoy their IV start experience, even if its 100% pain free.

And then there's the anticipation factor with Emla. I have parents who don't even use Emla on their toddlers prior to their ports being accessed because the hour of anticipation/anxiety isn't worth it and the kids scream just as much with or without it.

This thread has reminded me why I am a pediatric nurse, though. If an adult requested lidocaine prior to a peripheral IV start, I'd have a very hard time not rolling my eyes.

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We start IVs everyday. Hospital protocol is to use lidocaine. We are supposed to ask though what the patient prefers. We also have the pain ease spray but it only works for about 10 seconds so you have to be fast if you use that.

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Specializes in critical care, ER,ICU, CVSURG, CCU.

mostly on pedi er patients, but when it comes to me i apply emla, and then a bleb........ yea im that kind of "nurse patient" my excuse, im old ;)

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Specializes in critical care, ER,ICU, CVSURG, CCU.

the trick to not hurting with lido stick is very gradual and small injection, minimize tissue expansion

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Sorry but the lidocaine stick does not hurt as much as getting an IV. I refuse to let them start one until they do the lidocaine stick. The pain from an IV is horrible IMO. Not a problem at the one hospital I've had all my surgeries at-the ER automatically uses the lidocaine and so does pre-op. That's why I don't go to the other hospital system in my city.

Thank you, I totally agree, I've had the lidocaine in the past and it was nothing compared to the IV without lidocaine first. I appreciate everyone's comments, I started rethinking the lidocaine until your post. The IV stick was horrible. The spinal/epidural was nothing compared to the IV stick.

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We start IVs everyday. Hospital protocol is to use lidocaine. We are supposed to ask though what the patient prefers. We also have the pain ease spray but it only works for about 10 seconds so you have to be fast if you use that.

Kudos to the hospital for the protocol of "asking patients what they want". Hospitals, nurses, physicians, etc. should ask what the patient wants.

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I have had plenty of surgeries too, and blood draws. I am an extremely pick poke. As long as the person sticking me listens to my no sticks to the AC rule I would not want to bother with lidocaine.

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