Our IV team is being encouraged to offer local anesthesia for peripheral IV insertions. We currently use lidocaine ID or LMX creme with mixed results. I'd like to hear from others who do this on a regular basis. What products you use, pros and cons, etc. I'm especially interested in learning about the spray products. We haven't tried them yet. Thanks.
We use bacteriostatic 0.9% saline ID. Supposedly does not sting as bad as lidocaine. Pt's seem to tolerate it well.
I thought you would be interested in this article. Hope it helps. The references could assist you, also.
Administration of Local Anesthetic Agents to Decrease Pain Associated With Peripheral Vascular Access
Anderson, Steven; Cockrell, Jean; Beller, Pat; Murphy, Elizabeth; Nelson, Pat; Hawkins, Myra; Cederna-Moss, Joan
Journal of Infusion Nursing. 33(6):353-361, November/December 2010.
doi: 10.1097/NAN.0b013e3181f85628
The purpose of this study was to compare a variety of local anesthetic agents before starting an int...
Abstract:
The purpose of this study was to compare a variety of local anesthetic agents before starting an intravenous (IV) device to determine which method is the most comfortable for patients. Using a randomized, double-blind, placebo-controlled, pretest-posttest experimental design, the study compared 5 treatment groups (anesthetic spray, placebo spray, anesthetic intradermal injection, placebo intradermal injection, and a control group with no local anesthetic agent) in 84 emergency department patients. Pain was measured with a visual analog scale before and after the application of the local anesthetic agents and after IV insertion. Pain was significantly higher in the anesthetic intradermal injection group 1 minute after anesthetic application compared with the other treatment groups. Pain ratings 3 minutes after IV insertion were found to be similar for the 5 treatment groups. These study results do not support the use of intradermal anesthetic agents before IV catheter insertion.
Kathleen Wilson, CRNI
As a pediatric facility, it is our standard of care to use topical/local for venipunctures. The spray works quickly but only lasts a few seconds. It can be useful with very superficial veins. LMX cream still takes 30-45 min. We are most happy with the j-tip needleless lidocaine jet injector. It uses CO2 to inject lidocaine beneath the skin, works immediately, last several minutes, can be repeated if needed, and is not expensive.
Holly Hess
Peds Vascular Access
Jacksonville
FL
We also use bacteriostatic saline. I think it is the alcohol additive that deadens the nerves, our patients seem to like it, haven't had many complaints.
In connection with Kathleen Wilson's post, I'd like to invite you to an annual European society of regional anesthesia for a continuing education. This can benefit most nurse anesthetist and anesthesiologists for updates and latest trends about anesthesia.