Who numbs for needlesticks?


  • Specializes in Pediatrics, PACU. Has 20 years experience.

I am finding research about the pain of needlesticks and that it is good for patients long term if we don't subject children to the pain of needles. In addition to EMLA, there is LMX4 that is quicker (30 minutes), buffered lidocaine that can be injected with a 30 gauge needle almost painlessly or with a J tip and works in 1-3 minutes. According to some of the research I see, cold spray is helpful for IM injections, but not as much for pain associated with an IV start. There are mixed results about cold spray for IV starts. In addition there are other more expensive ways to decrease pain of needlesticks. These are probably the cheapest.

Who out there is using medicine or other devices to prevent pain of needlesticks in children? What do you use? Do you have a policy in place about it and how well are the employees able to follow it?


156 Posts

Specializes in NICU, PACU, Pediatrics. Has 16 years experience.

We use lmx4 in our preop dept and also use lidocaine depends on how old the patient is


14 Posts

Specializes in PICU. Has 3 years experience.

We are going through the process, inservices etc, in starting to use Painease, EMLA and LMX4 for needlesticks. Painease is the cold spray and it actually hurts a little when sprayed on the skin, in my opinion. I work in the PICU so we probably won't be using these products often, because they are not for emergent needlesticks. There are many instances in which you cannot use these products as well. I do believe it is a good idea because it may make the childs experience less painful and scarey.

Specializes in Pediatrics.

We use LMX cream for things like IM injections or port accesses; or lab draws if the family/patient want; and it does seem to help somewhat.

However, for IV starts, all of these numbing agents seem to have the characteristic of making beautiful veins disappear or at least constrict... I'm not sure why! For this reason, I rarely use it for the IVs because it usually ends up in more sticks/more pain for the patient; and it doesn't seem to help that much for the pain of IV starts when we have used it, anyway.

And I agree that the cold spray hurts!


1,476 Posts

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 17 years experience.

I agree with the post before me, it tends to make the vein disappear thus resulting in an increased number of sticks. I think there's research regarding the lidocaine in it and vasoconstriction


1,294 Posts

We try to numb. We have the cold spray, LMX or Synera patch available. Most often the Synera patch is used - it has lidocaine and a warming effect, the veins do not constrict.

We also use "sweet-ease" with the babies.

Specializes in Pediatric/Adolescent, Med-Surg.

At my pediatric facility, we only use LMX. It is a hospital policy that we have to offer it to all patients before a blood draw or IV stick. To encourage this policy, nurses are able to order LMX themselves, under a protocal order. However, we don't really use it alot on my floor, since I work with teenagers. Most of them are ok with getting stuck without LMX (the chronic ones with ports do get it for being accessed though).


1,476 Posts

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 17 years experience.

Christine...that's a nifty idea to allow the nurse to order it themselves. Considering I work night shift, I'd probably find myself using it more if I could order it rather than having to page a doctor in the middle of the night.


237 Posts

Specializes in emergency nursing-ENPC, CATN, CEN.

We use LMX-

We have Painease but that seems to make it sting ? alcohol content on the skin? We tried the "ZingO' which was pretty good but that was removed from availabilty

We mostly use non-pharm methods. I am currently QA 'ing our peds pts in the ED who need IV/labs to see how effective our methods are, anything we could do better, etc. We use non-pharm techniques (distraction, reassurance, imagery, pacifiers (for littlers) about 90% of the time and the parents report that they view it as effctive and would not "change" anything--


237 Posts

Specializes in emergency nursing-ENPC, CATN, CEN.

We also can orde LMX without the ED physician-- many times we apply it at triage as 'magic cream'--both antecubs. By the time they're done triage, in a treatment area--20 min or so have gone by to help the effectiveness


28 Posts

Specializes in Pediatric Emergency Medicine/Trauma.

Currently we have only Painease available without order. Unfortunately, being in an ER, we have to prep for blood cultures on almost every patient and according to our policy, we don't use Painease with blood cultures. And frankly, having practiced with it - it stings and feels like horrible freezer burn. As a nurse, it makes my beautiful veins disappear very quickly.

LMX and Emla are available but only with physician order so we use it solely with port access or difficult patients like autistic children.

We utilize Child Life for non-pharm management and they are amazing.


95 Posts

Specializes in paediatric and trauma. Has 3 years experience.

we use Emla or ametop

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