Created on April 1, 2010 using FlipShare.
When patients come into the hospital having an iv started is very common practice and while for nurses this may be deemed very routine for patients i can assure you it is vastly different many come with fear of needles fear of pain and severe anxiety related to having an i think in these patient concerns to heart and we have looked at the evidence and we have found
That there is good evidence based research to demonstrate the benefit to having an intradermal lidocaine practice prior to starting ivs research has shown us that patients want to be involved in that decision that many prefer to have lidocaine and that many find that the lidocaine is minimally discomforting compared to having an iv place we have listened with open
Hearts to your comments and concerns and we have tried very hard to address all of them the one concern that remains to be addressed is the lack of education on the process it’s and have put together a short video clip showing three willing participants having an iv started in the hand in the forearm and in the antecubital space using intradermal lidocaine you will
Be talked through the procedure step by step you will also hear the comments of the participants regarding how uncomfortable the lidocaine was and how uncomfortable the iv start was after having light a key so i ask you now to open your mind sit back relax and enjoy watching this short eight to ten minute video clip demonstrating the use of intradermal lighting
The first thing you want to do is place the tourniquet on and while the patient’s veins are being engorged and having better visibility as we’re gonna use the ac in this patient you can set up your light of cane and clean off the skin at this time the important thing when drawing up the lidocaine is to use a tv syringe the tb syringe is important because it has a
Smallest gauge needle has to cause less discomfort for the patient next you want to identify which vein you’re going to be cannulating in this instance we’re doing the ac as you can see the beginnings of the vein the vein starts about right here so this is where we’re going to want to inject the lidocaine now the volume of lidocaine that you inject does not have
To be substantial remember the pain receptors in the skin are very superficial so all you want to do is raise a wheel around the area that you’re going to place the needle in but you also have to make sure that you do not alter the anatomy of the vein by placing the lidocaine directly on top of the vein the vein starts here so i’m going to go approximately half
A centimeter distal to the vein and when i inject the wheel right here i will use that to enter the vein but again i’m being very careful not to place a lot of cane on top of the main and you want to count down for the patient on three and we just raise the skin wheel one two three and as you can see the skin wills not substantial but it’s there about how big
Is that as you can see with the tb syringe it’s about the size about half of this needles length okay and it was very superficial i penetrated very minimally with this needle you want to give it a few seconds how did that feel when he did that did the lytic aim very much mmm did you feel anything but a prick no just the prick now the important part is to remember
To enter through where the wheel is so now the wheel you may not be able to see it extends up to approximately right here where my finger is and that’s where i want to enter the vein at this time thread the catheter tell me about the whole experience well you expect the iv to hurt a lot more than the actual before the lidocaine because the needles much bigger than
The iv but when you put it in you couldn’t even feel anything at all now in this particular patient again which you first want to do is examine where the best vein would be to cannulate for demonstration purposes you could always consider this wrist pain you could just consider the side wrist vein which tends to be a very good vein to cannulate but since we already
Showed you an ac we’re now going to show you how to do a hand baine now with the hand vein again once you put on the tourniquet to minimize patient discomfort you want to have everything prepared beforehand but for intents and purposes i’ll show you how i prepare the the lidocaine again you only want to draw up at most about a half a cc of lidocaine more than this
Volume could obstruct the view of the vein when you’re injecting it cleaning off the hand and holding the skin tight and this considered into this scenario since the vein bifurcates right here a good spot to numb it up it would be right right before the bifurcation not on top of the vein this is not to obstruct it and right before where you’re going to insert the
Needle again warn the patient on three ready one two three a little lot so i’m a hold on i’m not okay and again now at this point you want to enter the vein right where you place a lidocaine cannulating the van thread the catheter and we’re done did you feel the did you feel the cannulation of the iv yeah okay but it was just the lidocaine that you felt mm-hmm
How would you say that the lidocaine hurt on a scale of one to ten but okay and it was primarily burning bernie for how long oh just for a couple of seconds okay okay all right and then you didn’t feel at all the placement of the catheter no not at all nope okay now in this patient we’re gonna do a forearm vein as you saw in the last two videos the ac doesn’t tend
To hurt very much in the hand will tend to hurt more again i’m repositioning the patient the patient understands well we’re gonna go he understands does he keep his arm in this position and now i’m going to clean off the area as i’m cleaning out the area the tourniquet is already on that way you’re saving a little time and another step i’m going to clean off a
Generous area i mean again i never draw up more than half a cc a lot of came in this video i’ll demonstrate the angle that i infiltrate the lidocaine with as well as the bevel now it’s important that you try to keep the bevel up if you remember but what these tb needles are so small it generally doesn’t make a large difference but again i’ll put in about half a
Cc of lidocaine you want to warn the patient that you’re gonna stick them and it’s very tough to see this vein but i can feel it right over here so i’m going to go right on top of the vein with the bevel up and again the angle is as flat as it can be to get a very superficial wheel one two three did that hurt not very much what was it elastane how would you rate
That pain from zero to ten three okay two three now you want to give it a few seconds for that lidocaine to really kick in and as you can see in this position again you want to straighten the arm palpate the vein again and you want to enter through the wheel because that’s the anesthetized skin and see how superficial this wheel is i didn’t penetrate very deeply
Right when the bevel was underneath the skin i injected approximately again 0.1 cc’s of lidocaine and again we see flash black that’s right off the catheter did you feel that you didn’t feel anything i would really want it if i had an iv in my hand for real
Transcribed from video
Using Intradermal Lidocaine Prior to Starting an IV By lhtrn1117