One of the most common invasive nursing procedures for  hospitalized patients, is the insertion of an intravenous catheter. IV sticks have a long track record of being painful, fearful and an unnecessary stressor for the patient. In an effort to promote comfort during intravenous cannulation, many hospitals have adopted policies that allow nurses to use local anesthetics to infiltrate the skin surrounding insertion sites. Such infiltrations, however, are known to cause painful stinging sensations, most likely due to the acidity of the solution. 

I have always been one of those nurses that believed infiltration of any substance around a target vein only hinders my ability to see the vein and causes the patient additional sticks. The ability to start difficult IV’s has always been my strong suit. So, I’ve always done it the “hard’ way for me … and my patients.  After reading this article cited below, I will be changing my practice patterns. What about you? 

Margo A. Halm, RN, PhD, APRN-BC, CCRN conducted a clinical review  to describe the current evidence related to the following question: Do different local anesthetic agents vary in their effectiveness in reducing the pain associated with intradermal infiltrations, or with insertion of an intravenous catheter and advancement of the cannula? Results were published in Am J Crit Care. 2008; 17(3):265-268.  Although some investigations have small samples, the combined findings from available studies may be considered class I evidence in support of buffered lidocaine providing less painful local anesthesia before intravenous cannulation. Warming lidocaine to body temperature (37°C), counter irritation, and administering the anesthetic slowly for 30 seconds are promising class IIb techniques that warrant more study. Class IIa evidence also exists in support of using 1% lidocaine or normal saline with benzyl alcohol to reduce pain associated with insertion of intravenous catheters.

Despite the evidence, and changes in hospital policy allowing lidocaine injections, researchers found that only 30% of RNs consistently offered intravenous lidocaine to reduce patients’ fear and pain. Nurses with higher self-perceived skills in inserting intravenous catheters and personal experience of having an intravenous catheter inserted with lidocaine were more likely to use this intervention. Another 23% used lidocaine only if patients appeared anxious, the intravenous site was a painful area, or multiple attempts had been made earlier. The other 47% of nurses did not offer lidocaine for the following reasons: a) they believed it made catheter insertion more difficult (flattening and obliterating veins), b) belief that  it was not reasonable to stick patients twice or, c) thought that there would not be sufficient pain relief to warrant the intervention.

I guess I’m not the only nurse who finds it difficult to accept current research and change my practice patterns. What do you do when you start an IV?