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musicfan_rn
Lidocaine in kits

I went to a pharmacy meeting Monday and they informed me the NS and lidocaine will be coming out of all kits -- PICC, central line, etc.  Their rationale is that they are meds not under their control and not secured, even though they are in a locked Pyxis supply cabinet which is in a locked IV room.  They assured me they have a NS available to drop on a sterile field and we will have to work on the lidocaine issue.  We usually have 2 RNs performing each PICC -- one setting up and documenting while the other one is assessing, measuring, and performing the procedure.  I think we will be able to get by with the 2 nurses, but it will present a little more of a problem when a nurse is by herself.  If the kit has the sterile syringe packaged in it, she could have a sterile and non-sterile hand and just don the other glove once she has drawn up the lidocaine.  Or they may be able to find a sterile lidocaine packaged separately we can drop on the field.

I did read somewhere in one of the forums a facility has the lidocaine in the med Pyxis.  What are some of the others of you doing?  Has your lidocaine come out of the kits?  If not, how did you convince your pharmacy to leave it?

Thanks in advance,

Sally RN

 

Kevertsz
I have been using Bard kits
I have been using Bard kits and several months ago, they removed the NS and Lidocaine.  I get both from a Pyxis.  The NS is packaged sterile.  It is opened and droppped onto the sterile field.  I use the flat end of a bottle opener to remove the top from the Lidocaine.  I set it close to the sterile field.  The kits have filtered straws and sterile syringes.  I use the straws to draw up the Lidocaine, then unscrew the straw, leaving it in the vial.  Since I work alone, I found this to be the easiest way to get the meds I need without contaminating my field.
musicfan_rn
Thanks!    

Thanks!

 

 

Alma Kooistra
So is that the wave of the
So is that the wave of the future......no more lido or saline in the kits?  I also use BARD and have been asking my rep when the lido or saline are coming back.  He does not respond to my questions on that issue.  If they're not coming back I'd think he could let me know..........  Do any of you who work with BARD have any insight on this?
Timothy L Creamer
We have been receiving Bard

We have been receiving Bard kits with an external small attached package containing the 5ml Lidocaine 1% ampule (in a padded protector) sterile encasement. No saline yet.

The lack of Lidocaine in the kits only accelerated our initiative to provide buffered Lidocaine for patient comfort. We now discard the Lidocaine ampules with our sharps post insertion. I can already see/hear the post comments about infection control and potential cross contamination regarding using a single or multidose vial of buffered Lidocaine. I am OK with constructive criticism and realize there are various techniques for this procedure. If our CRBSI rates had increased or stayed the same I would be concerned. Our rates were 0.5%/1000 cath days 2cd quarter and 0%/1000 cath days 3rd quarter (down from 3.8% 1st quarter) after making 3 significant improvements.

I do not know when the saline will be reappearing. Many facilities utilize sterile field prefilled syringes which can be dropped onto the sterile field. We are in the process of gaining approval for this product.

Our patients greatly appreciate the buffered Lidocaine and all report satisfied outcomes.

Hope this helps.

Timothy L. Creamer, RN

PICC Team Leader, Regional Medical Center Bayonet Point

Clinical Educator, Bard Access Systems

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

tbaugher
Tim,  I was wondering how

Tim,

 I was wondering how you are handling your preparation of the buffered lidocaine. I am looking into doing this but nursing teams in my area is not doing this, so I have no local PICC teams to reference. Would you be willing to share your process with me?  You may email me privately if you prefer not to post. Congrats on your CRBSI rates! Thanks in advance.

[email protected]

Timothy L Creamer
Terri, Happy to share.

Terri,

Happy to share. Pharmacy prepares and labels the vials including the expiration date (7 days). This is done every Monday morning. Contact your pharmacy director to discuss obtaining buffered Lidocaine (buffered with bicarb) and stress patient comfort/satisfaction outcome goals. Our pharmacy director was happy to help stating at his previously facility it was done routinely for pediatrics and the emergency department. Your pharmacy will ensure compliance with all Joint Commission requirements.

Check out Lynn Hadaways Blog, she spotlights an article featured on Medscape & eMedicine regarding local anesthetics (including buffered Lidocaine) efficacy. I believe it is the July posting on her blog.

Be sure you can assure pharmacy the Lidocaine vials will be securely stored in a locking style cart (combination lock promotes passive compliance versus a keyed lock).

Hope this helps and good luck, your patients will greatly appreciate your efforts.

Timothy L. Creamer, RN

PICC Team Leader, Regional Medical Center Bayonet Point

Clinical Educator, Bard Access Systems

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Greg Scott
We started purchasing the

We started purchasing the new Solo kits from Bard this past summer and only after we made the change did we find that we would not have lidocaine or saline in the kits for some time.  I had to change my procedure a little to accomadate the change.

I set the vials of saline and lidocain on a table close by with alcohol pads over the rubber stopper.  After I prepare my kit I use the one sterile and one dirt hand technique to draw the fluid into the syringes.  I also tie the tourniqet at this time.

Please comment if you see error in my technique.

Greg

Timothy L Creamer
Greg, we also were required

Greg, we also were required to change our methods, obtain lidocaine from a vial off the sterile field. Your one handed technique is appropriate however allow me to stress the importance of zero tolerance practice methods for infection prevention (was at a large hospital system today who changed the department title from Infection Control to Infection Prevention). If possible have someone assist with the lidocaine by holding the vial, unless you place PICC's alone like the majority of mine are then you must use the one handed technique. Review your technique, are you removing the needle with non sterile gloved hand after drawing up lidocaine, are you using 1" or 1 1/2" needle for draw, do you insert the entire needle into the vial or just enough so to keep syringe the maximum distance from vial?  I also perform this task just before tightening the tourniquet and changing gloves or removing outer pair depending on practice method. If you think any sterile item or field has been compromised please discard items or even the whole set up and start over. Remember, first do no harm. I discarded everything this weekend after opening all packages (the last one did the damge).

Hope this helps.

Timothy L. Creamer, RN

PICC Team Leader, Regional Medical Center Bayonet Point

Clinical Educator, Bard Access Systems

P.S. All the PICC insertion trays were affected, not just the SOLO kits.

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

afruitloop
The Arrow PICC's DO have

The Arrow PICC's DO have sterile prefilled saline syringes and lidocaine in every kit. They did  not have to pull these two components from the PICC kits when some of the other manufacturers did.  This makes things pretty user freindly!  FYI.

 Cheryl

Teleflex

Cheryl Kelley RN BSN, VA-BC

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