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Angela Lee
Standing protocol for topical/local anesthetics

Does anyone have a standing protocol for the use of local/topical anesthetics (Lidocaine injected, LMX4, Synera or anything else).   I would like to know how you have put that into place so that an MD order is not required for each patient and how you have addressed the issue of the anesthetic  being "prescribed" by the nurse.  Thank you

Gwen Irwin
We have Medical Executive

We have Medical Executive Council approval for the PICC insertion orders.  Those orders are initiated when a physician orders a PICC.  The PICC insertion orders include the local anesthesia and the chest xray for tip confirmation.

Gwen Irwin

Austin, Texas

Angela Lee
Thanks, Gwen, for your
Thanks, Gwen, for your response.  I guess I wasn't specific enough.  I am not asking about PICCs exclusively but all other venipuncture/needle procedures such as blood draws and PIVs to injections and heel sticks.  I would like to have a protocol in place so that some type of topical anesthetic can be applied to any patient within the hospital without having to get a specific order.  I believe this is one of the drawbacks to nurses not using topical anesthetics more.  So far I've been told this is prescriptive and therefore not likely to happen.
daylily
I have been asked to request

I have been asked to request more info. on this as well.  We have an anesthetic policy that states unlicensed prof. can use a topical anesthetic prior to venipuncture.  This has recently come under question.  Are there other facilities in New York State allow this?

For nurses that are using this "per protocol" is it documented on the medication administration record?  Currently we have just been documenting its use and effectiveness when we document our IV start.

Gwen Irwin
We also have the same

We also have the same Medical Executive Council support for using lidocaine for peripheral IV starts.  The anesthesiologists were in great support of this policy.  Howevern, it does not include lab draws.

Gwen Irwin

Austin, Texas

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