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Archive January 2019 XX, No. 1

Ideas That Work: Pre-Incision Lidocaine

The Secret to Painless IV Starts

David Smith, RN, BSN
A LITTLE STICK When it comes to painless IV starts, 2 sticks are better than 1 — first subdermal lidocaine to numb the area, followed by the IV catheter, which patients might not feel at all.

It's no great secret that injecting a small amount of 1% lidocaine under the skin just before the venipuncture will make IV starts a painless breeze for both patients and nurses, who can take their time to do the stick, knowing they aren't causing the patient any discomfort with the attempt. The trick, though, is getting your pre-op nurses to routinely use subdermal lidocaine. Here's how to counter the excuses you're likely to hear:

1. "It's 2 sticks and it takes more time!" Yes, of course, but the 30 gauge needle they'll use to administer lidocaine is much smaller — and much less painful! — than the 20 gauge IV needle. Stress to your nurses that when they perform venipuncture, the patient will only feel some pressure but no stick.

2. "But it stings!" Yes, but only for a second. Patients might feel a brief stinging sensation just as the lidocaine takes effect, but the numbing agent takes effect almost immediately. Stress to your nurses that they're using an anesthetic with a tiny needle to numb the area so their patients will feel little to no pain. Put another way: You're using a tiny needle to solve a big problem.

3. "It's hard to administer lidocaine!" No, it isn't. A few administration tips:

  • Press with the flat side of your 30 gauge needle (to minimize bleeding) onto the skin, bevel up. This could fatigue the nerves a bit and work in your favor.
  • Spill a small amount of lidocaine on the site.
  • Inject slowly as you advance the needle to minimize the discomfort of tissue expansion and spread the lidocaine in front of the advancing needle. Inject until a weal forms. Also, inject as you withdraw to minimize discomfort.
  • Clean the site again and press on the site to displace fluid so site markers are more visible. It may sting again as the lidocaine is dispersed.

David Smith, RN, BSN
St. Davids Medical Center
Austin, Texas

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