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V A S C U L A R
A C C E S S
AN ANESTHESIOLOGIST'S VIEW
IV Starts Take "Experience and Courage"
S
tarting IVs well takes experience and
courage. I always use local anesthesia once
I've identified the best location. This takes
experience, too. Some veins must be found by palpation and can't be visualized, but they are found in the
LOCAL ANALGESIA Many
providers never start an IV
without first injecting the site
with lidocaine.
usual locations. Always inject about 1/10cc lidocaine
plain 0.5% and then compress the weal to disperse the local and identify the
vein again. Carefully puncture the skin, usually in the location of the needle
puncture from the local, and look for flash in your needle hub. Once seen, you
can advance the catheter off the needle into the vein.
Some will argue there is pain from the injection of the local, so they don't or
won't do it. Others argue that the injection obscures the vein. But if done the
way I described, you'll still have good landmarks and a happier patient who's
not complaining about the pain from the IV stick due to "preemptive analgesia" of the local in the skin. Otherwise, you may have a successful vein cannulation, but the patient will complain about the pain, which makes an unhappy patient until the catheter is withdrawn. This doesn't always ensure the
pain will go away, either.
— Dean B. Berkus, MD
Dr. Berkus (dberkus@pacbell.net) is an anesthesiologist at Specialty
Surgical Center in Beverly Hills, Calif.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J A N U A R Y 2013
