Second OpinionsDoes an IV need to be in place for cases...

Does an IV need to be in place for cases involving local anesthesia?

We are interested in the practice of other ASCs regarding the requirement for an IV (at least a reseal) prior to a straight local case.
Seeking both your practice and any potential support in the literature. Our policy is to have an IV reseal in place for the potential response to an untoward occurrence.

Started by: Nancy Burden (Administrator/Director/Manager/Owner/Exec. Officer) at August 11, 2011 (10:25 am)

Comments and Responses

 

Have y'all ever gone to the dentist for a cavity fill? Guess what, you're receiving lidocaine!! This is considered a "local anesthesia block". How many of y'all receive an IV when your at the dentist? I certainly have not.
I highly disagree with a majority of the comments left here. I have worked in a perioperative department for 12 years, 2 of which as a nurse manager. We routinely administer local anesthesia for minor procedures, no IV's required, and have never, ever had any issues. In fact, patients appreciate not having an IV (cause for infiltration risk etc). Our staff are well trained on local anesthesia monitoring as well.Maybe some great educational training and a fresh look at updating policy is what is needed across the US concerning local anesthesia administration.
Does anyone have evidence based data backing the requirement for an IV when a patient is given local anesthesia? I have never, in all my research, found anything stating an IV is required or necessary.

Jaynel Hollis (OR Manager/Supervisor) at September 21, 2018 (6:29 pm) [last edited on September 21, 2018 (6:32 pm)]

We always start an IV. If it is local/minor procedure, it can be just a saline lock, and is usually a 22 or 24g, just to have access with as little pain as possible. If anything happens, we have no legal defense. It is nice to not inflict pain on our patients, but a little poke could be the difference between a good and not so good outcome.

Mark B. (OR Manager/Supervisor) at August 24, 2011 (4:20 pm)

We do not require IVs on minor local anesthesia patients. If there is any question, or if it is ordered as anesthesia standby we start one. Is a lesion removal really any different than when a patient goes to the ER for stitches or the dentist for work? We apply the monitors and IVs are available but it is not routinely done.

Ermel H. (OR Manager/Supervisor) at August 15, 2011 (4:24 pm)

baancing patient comfort with patient safety can sometimes be difficult. I guess considering the number of nurses, facilities and surgeons I've worked with in 20 years who have NO CLUE as to what the limit doses and toxic effects of local anesthetics are, I would certainly not want to be the one standing there providing sweet words of comfort as the patient seizes or has a cradiac arrest! Think about what your legal defense would be if something happened? better yet, how many facilities actually have an inservice on locals and toxicity levels?

S. Berkowitz (Anesthesiologist/Nurse Anesthetist) at August 12, 2011 (11:44 am)

Saline locks are placed on all patients going to the OR, as well as routine monitoring of SpO2, NIBP and ECG. If the patient experiences an unexpected complication/reaction their peripheral vascular system is the first to shut down. Try finding IV access then. Better safe than sorry.

M. SMITH (Director, Surgical Services/Director of Nursing) at August 12, 2011 (9:21 am)

Saline locks are placed on all patients going to the OR, as well as routine monitoring of SpO2, NIBP and ECG. If the patient experiences an unexpected complication/reaction their peripheral vascular system is the first to shut down. Try finding IV access then. Better safe than sorry.

MELINDA SMITH (Director, Surgical Services/Director of Nursing) at August 12, 2011 (9:20 am)

Saline locks are placed on all patients going to the OR, as well as routine monitoring of SpO2, NIBP and ECG. If the patient experiences an unexpected complication/reaction their peripheral vascular system is the first to shut down. Try finding IV access then. Better safe than sorry.

MELINDA SMITH (Director, Surgical Services/Director of Nursing) at August 12, 2011 (9:20 am) [last edited on August 12, 2011 (9:20 am)]

We do not start IV's on local procedures at my facility, unless a pre-op IV antibiotic is ordered, which is rare.

Dawn Vocke (OR Manager/Supervisor) at August 12, 2011 (8:09 am)

We do not mandate an IV on straight locals where there is no anesthesia professional present in the case. We leave the decision to the physician performing the procedure to make the call. We do have the items needed to start one immediately available in the room.

Catherine M. (Other) at August 12, 2011 (7:41 am)

My facility ALWAYS starts at least a HepLock on every patient, regardless of the type of anesthesia. You never know what untoward reaction a patient may have and you don't want to find yourself fumbling with an IV insertion when you really need the access. "An ounce of prevention is worth a pound of cure."

LUISA P. (OR Manager/Supervisor) at August 11, 2011 (6:55 pm)

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