Starting IV's

It's acceptable in OR's, ERs are allowed to but many nurses don't. I believe other areas need an order for it.

We have an order and a policy to allow this. As a result it is up to the Nurse's discretion and the pt.'s allergies in my facility.

okay this just happened to me yesterday! I guess my hospital has a protocol that RN's can use lido for IV! HOWEVER...lido tends to shrink vessels or make them very sensitive (roll potential) so many people in the know will not use it!!!!!!!!!

So I handled it this way when the patient insisited...I gave her 5 mg of valium and told her about the effects of valium to ease her...and I had an ER nurse (20 years experience and was a paramedic) come in and stick...Boom it was over in two seconds (in fact I was soooooooo impressed I got goosebumps!!!!!!!), and she said it was her best experience with IV's (she was a hard stick!). She honestly didn't feel anything! She was overly impressed..and frankly..so was I!!!!!!

So something I learned :)

I work in the OR and I always use lidocane if starting an 18g or larger. Sometimes even for a 20g depending on the situation. I have never seen lidocaine shrink a vessel or cause one to roll. We have standing orders and our pharmacy has them pre drawn up and labled for us on the IV cart.

Awesome CuttingEdgeRN...I have not used it but those that I work with said that was a large probelm...but I never believe in something I never tried or had experience myself in certain situations....

But I will say this...I looked at her arm before the valium and nothing was there...after..there was this great vein poking out like "take me!" after 15 minutes and without heat! COOL! Not that I will give valium to all pts..but wow...that was pretty cool on her!

That's news to me. I'm familliar with using Emla or Ametop prior to starting IVs. Ametop is preferred as it does not seem to affect the veins as Emla does. Only problem is you have to leave it on for 30 mins before it "numbs" the skin.

Cheers,

RNAnnjeh

As a patient who has had many IVs and been stuck too many times, I appreciate any nurse that will take the time to give me a local.

I beleive it should be patient preverence. Personally I would rather have the one stick which causes about 10 seconds of pain (of course that depends on who is doing the sticking ) and get it over with than have two or more sticks... Just my own oppinion. sorry all for my awful spelling.

Swtooth

So I handled it this way when the patient insisited...I gave her 5 mg of valium and told her about the effects of valium to ease her...

Valium...for an IV start?!? I've never heard of such a thing!

I've never had a problem with Lidocaine shrinking or displacing a vein. I always offer it to anything bigger than a 20g. Anything 22 or less and the "poke and sting" is equal to the actual IV poke itself.

Now, peds IV starts (pre-op) can wait until they have a little "gas" in the OR for minor procedures, it the OR will allow it, IMHO.

In the ER i work i have never seen anyone use a local just for an IV. Seems kinda silly to me. I have had IV's before and its really not that painful. I dont think the lidocaine would constrict the vessels either though unless you were using lidocaine w/ epi. The epi would make the vessels constrict. The docs use the lido with epi b/c it decreases bleeding durring suturing procedures and use lido without epi when suturing things like fingers because it could stop the blood flow completely. That is how i have understood it... correct me if I'm wrong :)

our hospital protocol states that we "have" to use a numbing agent to start an iv. we have vials of buffered lidocaine in all the med carts. but then of course there are nurses that don't like to use it because it makes for a harder stick, they say the veins tend to "disappear".

i've heard that we can also use ns, the "bleb" displaces the nerve endings, making the iv insertion less painful.

Seems kinda silly to me. I have had IV's before and its really not that painful.

Remember, pain (or really anything) is what the patient says it is. Because it's not painful to you really doesn't mean it isn't for your patient.

Lido is always an option for our patients. Never had any problems starting an IV after giving lido.