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Lidocaine to ease pain
Early in his career, a nurse anesthetist suggested to Chris
Lippert, RN, CAPA, that he use lidocaine on his patients before IV
starts. It ended up being sound advice.
"It was amazing to me how patients suddenly didn't get upset with
me over starting their IVs," says Mr. Lippert, OR director at Avera
Queen of Peace Hospital in Mitchell, S.D.
Inject lidocaine just under the skin with a small (27-guage) hypoder-
mic needle to anesthetize the tissue around where you're going to
place the IV. Then you can go in with a larger catheter (18-guage) and
the patient will have less discomfort with the IV start because the skin
is already numbed.
"Once I use the lidocaine, I'm willing to say that 75% of the people
that I stick tell me that they did not feel the IV catheter go in," says
Mr. Lippert.
You can give lidocaine as a patch (put it on the patient 45 minutes
to an hour before the IV start), a topical cream that takes 15 to 30
minutes to take effect — apply the cream to 2 or 3 areas of the skin
in case you can't find the vein you want — or as an injection.
"When you inject local anesthesia into the skin, you are creating a
space where there was none, and you have to create a space in the tis-
sue," says Dr. Gravenstein. "So, inject it slowly."
You can also use a needle-free jet injection device, which you press
against the site where you want to insert the IV. It uses carbon dioxide
instead of a needle to propel aerosolized lidocaine through the skin. It
works immediately, "but it makes a loud, hissing sound, like you're
opening a can of soda … which can make patients anxious," says
Sulpicio Soriano, MD, FAAP, endowed chair in pediatric neuroanes-
thesia at Boston Children's Hospital and professor of anesthesiology
at Harvard Medical School.
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IV Tips & Tricks
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